What daughter of mine would you like to date?  Please pick Jamie Brenda I'm a pervert, Both

Your First Name Last Name

Date of Birth mm/dd/yy

Height Weight

Highest School Grade completed 1 2 3 4 5 6 7 8 9 10 11 12 K Select

Name of the College you attended if any

License Plate #

Home Address

Name of your Dentist

Name of your Doctor (and please let him know we want info on your history and to release all info to us on request)

Do you have one male and one female parent Select Yes No

If no, explain

How long have your parents been married Select I'm too dumb to know! They are not Married Less than a week Less than a month Less than a year 1 to 5 years 5 to 10 years 10 to 20 years over 20 years

Please check all that apply to you:

Do you own a van?

A truck with oversized tires?

A waterbed?

Any body piercing?

If you have any piercing, where

A tattoo?

If you have any tattoos, where and of what

In ten words or less what does "LATE" mean to you?

In ten words or less what does "Don't touch my daughter" mean to you?

In ten words or less what does "ABSTINENCE" mean to you?

What church do you attend?

When would be the best time to interview your Parents?

What do you want to be IF you grow up?

If you were shot, where wouldn't you want to be hit?

What bone would you not what to have broken?

What don't you want us to ask you about?

When you meet a girl, what is the first thing you notice about her?