Application to Date My

Daughter
Name: Last: ____________________ First: _______________________ Middle Initial: __________ Age:
_____
Address: ____________________________________ City: ____________________ Country:
_____________
Religion: _____________ Church: _____________________________ Number of attendance in last
year: ____
Family Information
Fathers Name: ________________________________ # Marriages: ___________________ # Years
____
Address: _______________________________________________________________________________
Mothers Name: ________________________________ # Marriages: ___________________ # Years
____
1. Do you own or drive a van? Yes/No (If Yes, please discountinue filling out this form).
2. In 50 words or less, describe what NO means to you.
______________________________________
__________________________________________________________________________________
3. In 50 words or less, describe what LATE means to you.
____________________________________
__________________________________________________________________________________
4. Where would you least like to be shot?
___________________________________________________
5. Which is the last bone you want broken?
_________________________________________________
6. What do you want to be IF you grow up?
________________________________________________
7. Please complete this sentence: A Womans place is
______________________________________
_________________________________________________________________________________
8. What is my daughters name?
__________________________________________________________
9. Who, besides God. Should you fear the most?
______________________________________________
__________________________________________________________________________________
Please list down three references
Name of Parents
relationship ended

Name of Daughter

Reason

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________

Special Notice: If accepted, there will be a $50.00 deposit when you pick up my Daughter.
If you are one minute late, the deposit will be forfeited without notice.
If you are more than 30 minutes late, please refer to question number 5 to find the answer.