Pure-Essence.Net

Application to Date My Daughter

(REVOCABLE AT ANY TIME)

NOTE - This application will be Incomplete and rejected unless accompanied by a complete financial statement, job history, lineage, and current medical report from your doctor.

1. NAME:_____________ DATE OF BIRTH: ________
2. HEIGHT:___________ WEIGHT: ______IQ: ________GPA: ______
3. SOCIAL SECURITY #: ___________DRIVERS LICENSE #: _________
4. BOY SCOUT RANK:_______________________________________
5. HOME ADDRESS: ________________CITY: _________ ZIP ______
6. Do you have one MALE and one FEMALE parent? Yes____ No_______ If NO, explain: ________________________________
7. Number of years parents married: ___________
8. DO YOU OWN A VAN? ____ A TRUCK WITH OVERSIZED TIRES OR CAMPER SHELL? ____ WATERBED? _____ MOTORCYCLE? _____ TATOO? ____ COLOR ALTERED HAIR? ___ (IF YES TO ANY PART OF #8, DISCONTINUE APPLICATION AND LEAVE PREMISES IMMEDIATELY)
9. In 50 words or less, what does “Late” mean to you? ________________________________
10. In 50 words or less, what does “DO NOT TOUCH MY DAUGHTER” mean to you? ________________________
11. In 50 words or less, what does “ABSTINENCE” mean to you? ___________________________
12. What church do you attend? ________________ How often do you attend? ____/ week
13. When would be the best time to interview your father, mother, priest or pastor? ____________
14. Fill in the blanks: Please answer freely - all answers are confidential (That means I won’t tell anyone - 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 I would want broken is my _____________
C. A women’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 _____________________ (NOTE: If the answer to “E” begins with a B, T, or A, discontinue and leave the premises immediately with your head hung low.)
15. What do you want to be IF you grow up? _________________________
16. Do you plan to attend a Catholic or Christian College? _________ Which one? ____________

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, AND RED HOT POKERS.

_____________________ Signature (That means sign your name)

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 (this action will void this application). If your application is rejected you will be notified by two angels wearing red suits and carrying pitch forks. (You might want to start praying now).