Application to Date Our Daughter

  1. Place your Photo here.
  2. Name
    Date of birth
    Phone Number
    Social Security Number
    Boy Scout rank
    Mother’s name
    Father’s name
  3. Do you own or have any of these items:

    ___ motorcycle
    ___ muscle car or sports car
    ___ earring or piercing anywhere
    ___ van
    ___ firearm
    ___ tattoo
    ___ truck with oversized tires
    ___ exotic pet, such as a snake
    ___ electric guitar

    [If you checked any of these items, discontinue application and leave immediately.]

  4. Do you:
    Do you smoke? Yes No
    Do you drink? Yes No
    Do you gamble? Yes No
    Have you ever been arrested? Yes No
    Do you ever drive over the speed limit? Yes No
    Have you ever seen Elvis? Yes No
    Have you ever seen a UFO? Yes No
    Have you ever seen Elvis in a UFO? Yes No
    Watched a porn video? Yes No

    [If you answered Yes to any of the preceeding questions, discontinue application and leave immediately.]

  5. Preferred dating activity:
  6. ___ Walk in the park
    ___ Watch a School play
    ___ Minature Golf

  7. In 50 words or less, tell exactly what the words “Don’t be late” mean to you.
  8. You must attach a complete police record and latest diploma or transcript.
  9. Signatures:

    Your Signature: _____________________________

    Parents’ signatures:____________________________ _________________________________

    Police Chief’s signature: ______________________________

  10. [Please allow 4 to 6 years for processing. Any unanswered questions will result in forfeiture of application. Apply at your own risk.