NOTE: This application will be incomplete and
rejected unless accompanied by a complete
financial statement, job history
and current medical report from your doctor.
1.
Name _____________________________________ Date of Birth ______________________
2. Height _______________ Weight ______________ I.Q. ________ G.P.A. ________________
3. Social Insurance Number ________________ Driver’s License Number ________________
4.
Boy Scout Rank ______________________________________________________________
5.
Home Address _______________________________________________________________
6.
Do you have one Male and one Female parent? Yes
___ No ___
If No,
Please explain __________________________________________________________
7.
Number of Years Parents Married: ______________
8.
Do you own a car? Yes ___ No ___
truck with oversize tires? Yes
___ No ___
9. Do you have an earring, nose ring or bellybutton ring? _____________________________
10.
In 50 words or less, what does Late mean to you?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
11.
In 50 words or less, what does Don’t
Touch My Daughter mean
to you?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
12.
In 50 words or less, what does Abstinence mean to you?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
13.
What church do you attend? _______________________ How often?
_____________________
14.
When would be the best time to interview your Father?
________________________________
Your Mother?
____________________________________________________________________
15.
Answer by filling in the blanks. (Please answer freely.) All answers are
confidential:
a) If I were shot, the last place on my body I
would like to be wounded is ______________________
b) If I were beaten, the last bone I would want
broken is ______________________________________
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 about her is ________________________________
NOTE:
If answer begins with T or A, discontinue and leave the premises,
keeping head
low and running in a
serpentine pattern is advised.
16.
What do you want to be If you grow up?
_____________________________________________
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, Crucification, Electrocution,
Chinese
Water
Torture and Hilary Clinton Kiss Torture.
_______________________________
____________________________________________
Date Signature
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