FULL NAME________________________________________________
DATE OF BIRTH____/_____/_____
HEIGHT____________ WEIGHT_____________
I.Q.__________
GPA_____________
SOCIAL SECURITY #___________________
DRIVERS LICENSE #________________
BOY SCOUT RANK AND BADGES____________________________________
HOME ADDRESS__________________________
CITY__________________
STATE/PROVINCE__________________
ZIP/POSTAL CODE_________
Do you have ONE male and ONE female
parent?
________________________________
If NO, please explain
_____________________________________________________________
_____________________________________________________________
Number of years they have been married
__________________________________________________________
If less than your age, explain
_____________________________________________________________
Do you own a van? _____________
A truck with oversized tires?__________
A waterbed?_____________
A pickup with a mattress in the back?________
A condom?_______________
Pornography?_______________
Do you have an earring, nose ring,
or a belly button ring?__________
A tattoo?_____________
(IF YES TO ANY OF THE ABOVE, DISCONTINUE
APPLICATION AND LEAVE PREMISES)
In 50 words or less, what does LATE
mean to you?
_____________________________________________________________
_____________________________________________________________
In 50 words or less, what does DON'T
TOUCH MY DAUGHTER, mean to you?
_____________________________________________________________
_____________________________________________________________
In 50 words or less, what does ABSTINENCE
mean to you?
_____________________________________________________________
_____________________________________________________________
Church you attend ________________________________________________________
How often you attend ______________________________________________________
And why not? If less than 52 weeks
per year.
_____________________________________________________________
When would be the best time to interview
your:
father? _______________
mother? ______________
priest?_______________
parole officer?_________
Answer by filling in the blank.
Please answer freely, all answers are confidential.
A: If I were shot, the last place
I would want shot would be:
______________________________________________________________
B: If I were beaten, the last bone
I would want broken is my:
______________________________________________________________
C: A woman's place is in the:_______________________________________________
D: The one thing I hope this application does not ask me about is: __________________________________________________________
E: When I first meet a girl, the thing
I notice about her first is: __________________________________________________________
(NOTE: if answer E begins with T or
A, discontinue. Leaving premises keeping your head low and running
in a serpentine fashion is advised.)
What do you want to do IF you grow
up?
______________________________________________________________
What is the current going rate of a
hotel room?
______________________________________________________________
Condoms come in packages of (circle
one)
A: 3
B: 6
C: 9
D: 12
E: ALL OF THE ABOVE
How do you know?
___________________________________________________
I SWEAR THAT ALL INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT, NATIVE AMERICAN ANT-TORTURE, CRUCIFIXION, ELECTROCUTION, CHINESE WATER TORTURE, RED HOT POKERS, AND HILLARY CLINTON KISS TORTURE.
-------------------------------------
Thank you for your interest. Please allow four to six years for processing.You will be contacted in writing if you are approved. Please do not try to call or write (since you probably can't, and it would cause you injury). If your application is rejected, you will be notified by two gentleman wearing black shirts and white ties carrying violin cases (you might want to watch your back).