APPLICATION TO DATE SEBASTIAN BARR

Name: Phone: USCF Ranking: Height (in cubits): Date of Birth: City:

Cumulative GPA (optional but in your best interest): Hair Color: Eye Color:

Are you willing to pay for your own expenses on a date? Are you a licensed driver and have access to a motor vehicle. Do you or anyone in your family have any undesirable genetic defects? If yes, explain.

Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ]

Have you ever made contact with extraterrestrial beings? If yes, briefly explain and contact the Canadian government. Yes [ ] No [ ]

Current Employment (if any): Favorite Movies:

Preferred Music (genres, artists, etc.):

Hobbies/Skills:

What is your favorite marsupial? Suggested Date Activities:

[ ] I accept that neither I nor Sebastian intend to exclusively date or pair off with any one individual. I am aware that one date is not a binding contract for more. If an initial date is satisfactory, an individual may qualify for subsequent dates.
I certify and affirm that I am 16 years of age or older, that all information presented in this application is true and correct. I make this certification and affirmation under penalty of perjury and understand that knowingly making a false statement on this application is a criminal violationsort of.

Applicant Signature: Parent/Guardian Signature: