NOTE: This application will be incomplete and rejected unless accompanied by a complete financial statement, job history, copy of signed Teenager Driving Contract, and current medical report from your doctor.
NAME: _______________________________________
DATE OF BIRTH: ________________________
HEIGHT: ________ WEIGHT: _________
HAIR COLOR: __________ EYE COLOR: _________
BIRTHMARKS: _________________________________
IQ: _________ GPA: ______________
SOCIAL SECURITY #: _________________________
DRIVER'S LICENSE #: _________________________
BOY SCOUT RANK AND BADGES: __________________
_____________________________________________
_____________________________________________
SCHOOLS ATTENDED: ___________________________
_____________________________________________
_____________________________________________
EXTRACURRICULAR ACTIVITIES: _________________
_____________________________________________
_____________________________________________
HOME ADDRESS: _______________________________
_____________________________________________
CITY/STATE: _________________________________
___________________________ ZIP: __________
TELEPHONE: _________________________________
EMAIL: _____________________________________
Do you own a van? ____ A truck with oversized tires? ____
A waterbed? ____ A pickup with a mattress in the back? ____
A pager? _____
Do you have an ear ring, a nose ring, or a belly button ring? ____
A tattoo? ____
(IF YES TO ANY OF the ABOVE, DISCONTINUE APPLICATION AND LEAVE PREMISES.)
In 50 words or less, what does LATE mean to you? __________
________________________________________________________
________________________________________________________
In 50 words or less, what does DON’T TOUCH MY DAUGHTER mean to you?
________________________________________________________
________________________________________________________
________________________________________________________
In 50 words or less, what does ABSTINENCE mean to you?
________________________________________________________
________________________________________________________
________________________________________________________
Church you attend: ________________________________________
How often you attend: _____________________________________
When would be the best time to interview your father, mother, and pastor? ______________
Answer by filing in the blank. Please answer freely. All answers are confidential (that means I won’t tell anyone EVER).
A. If I were shot, the last place I would want to be shot would be _____________________
B. If I were beaten, the last bone I would want broken is my _________________________
C. The one thing I hope this application does not ask me about is ______________________
D. When I meet a girl, the first thing I notice about her is ____________________________
(IF ANSWER to D. BEGINS WITH “T” OR “A”, DISCONTINUE APPLICATION AND LEAVE PREMISES IMMEDIATELY.)
What do you want to do IF you grow up? ___________________
______________________________________________________
______________________________________________________
______________________________________________________
I SWEAR THAT ALL INFORMATION SUPPLIED ON THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT, ELECTROCUTION AND RED HOT POKERS.
______________________________________ SIGNATURE (that means 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. If your application is rejected, you will be notified by two gentleman wearing white ties and carrying violin cases.
(Source unknown)





