Application to date our daughter




Place your

Photo here.




Name ____________________

Date of birth _______________



Phone Number_____________

S.S. Number_______________

Boy Scout rank_____________

Mother's name _____________

Father's name ______________


Do you own any of these items:

motorcycle muscle car or sports car earing
van firearm tattoo
truck with oversized tires exotic pet, such as a snake electric guitar

If you checked any of these items, discontinue application and leave immediately.

Do you smoke? Yes No
Do you drink? Yes No
Do you gamble? Yes No
Have you ever been arrested? Yes No
Do you ever drive over the speed limit? Yes No
Have you ever seen Elvis? Yes No
Have you ever seen a UFO? Yes No
Have you ever seen Elvis in a UFO? Yes No

If you answered Yes to any of the preceding questions, discontinue application and leave immediately.


Preferred dating activity:

Walk in the park Watch a School play Miniature Golf


In 50 words or less, tell exactly what the words "Don't be late" mean to you.




You must attach a complete police record and latest diploma or transcript.


Parents' signatures____________________                               ____________________

Police Chief's signature ______________________


Please allow 4 to 6 years for processing.

Any unanswered questions will result in forfeiture of application.

Apply at your own risk.      NOT equal opportunity parents.