APPLICATION FOR PERMISSION TO DATE MY DAUGHTER
   
   This application must be answered in full prior to permission 
   being granted to date my daughter.  Remember all answers will 
   be checked for valid responses.  Please consult your life 
   insurance agent to verify that all beneficiaries are current 
   and additional coverage is applied for if needed prior to 
   turning this application in.
   
   Name:_________________     Date of Birth:___________________
   Home Address:_______________________________ City:__________ 
   State:_________ Zip:___________
   Social Security #:________________________________  
   Drivers License #:________________________________
   Height:_________  Weight:__________ 
   I.Q.:________ G.P.A.:___________
   Boy Scout Rank:_____________
   
   1. Do you have one male and one female parent? (Yes / No)
   If no, explain: ____________________________________________
   2. Do you own a van? (Yes / No)
      a truck with over-sized tires? (Yes / No)
      a waterbed? (Yes / No)
   (Note: if you answer yes to any of #2, put down your pencil, 
 discontinue
 application, and leave premises)
   3. In 50 words or less, what does LATE mean to you?_________
   ____________________________________________________________
   ____________________________________________________________
   ____________________________________________________________
   4. In 50 words or less, what does DON'T TOUCH MY DAUGHTER 
   mean to you? _______________________________________________
   ____________________________________________________________
   ____________________________________________________________
   5. In 50 words or less, what does ABSTINENCE mean to you?_
   ____________________________________________________________
   ____________________________________________________________
   ____________________________________________________________
   6. Do you have an ear ring, nose ring, belly-button ring or 
   tattoo? (Yes / No)
   (Note: if you answer YES to any of #6, put down your pencil,
 discontinue application, and leave premises).
   7. Do you attend church: (Yes / No)
      How often do you attend?_________
   8. When would be the best time to interview your father, mother,
 priest/pastor?
   ____________________________________________________________
   9. Answer by filling in the blank. Please answer freely - all answers
 are confidential.
   (That means I won't tell anyone - ever - I promise.)
        A. If I were shot, the last place on my body I would want to be
 wounded is in the . . . 
   ___________________________________________________________
         B. If I were beaten, the last bone in my body 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 first thing I notice is her . . .
   ____________________________________________________________
   (Note: If answer E begins with "T" or "A", put down your pencil, discontinue application, 
and leave premises