Name_________________________ Date of Birth____________

Height _________ Weight________ IQ________ GPA________

Social Security # ______________ Driver's licence #__________

Boy Scout Rank_____________________________________

Home Address_____________ City/State ____________ Zip____

Do you have one male and one female parent? ____________

If no, explain answer _________________________________

Number of years parents married ________________________

Do you own a van? _______ A truck with oversized tires?______

Do you have an earring, nose ring, or belly button ring? _______

Do you have a tattoo?_________

(if yes to any of #8, discontinue application and leave the 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? __________________________________________________________.

Church you attend _______________

How often do you attend? _______________________

When is the best time to interview you father, mother, and bishop?

Father ____________ Mother___________ Bishop__________

Answer by filling in the blank: please answer all questions freely, all answers are confidential (that means I won't tell anyone ever- -promise)

A. If I were shot, the last place I would want to be wounded is in the __________________

B. If I were beaten, the last bone I would want broke is my ____________

C. A woman's place is in the _________________________

D. The one thing I hope this application doesn't ask is __________________________________________________

E. When I first meet a girl, the thing I notice about her first is ______________

What do you want to be 'if' you grow up? ________________

Are you willing to wear an electronic tracking device? _______

I swear all information supplied above is true and correct to the best of my knowledge under penalty of death, dismemberment, crucifixion, electrocution, chinese water torture, and red hot pokers.

Signature ________________________

Thank-you for you 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 gentlemen wearing white ties carrying violin cases (you might watch you back).