Personal Information
Name:
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Age:
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Last, First, Middle
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Address:
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Street, City, State
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Religion:
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Church:
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Times attended last year:
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Wikipedia edit count:
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Commons edit count:
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Administrator?
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Yes/No
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Arbiter?
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Yes/No
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Founder?
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Yes/No
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Number of Sockpuppets:
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Family Information
Father’s Name:
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# Marriages:
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# Years:
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Address:
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Mother’s Name:
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# Marriages:
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# Years:
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Address:
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Non-Optional Questions
1.
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Do you own or drive a "van"? Yes/No
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(If yes, disregard the remainder of this form)
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2.
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In 50 words or less, describe what "no" means to you:
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3.
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In 50 words or less, describe what "late" means to you:
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4.
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Where would you least like to be shot?
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5.
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Which is the last bone you want broken?
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6.
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What do you want to be if you grow up?
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7.
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Complete this sentence:
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“A woman’s place is _______________________”
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8.
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What is my daughter’s name?
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9.
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Who, besides God, should you fear most?
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10.
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List Three Reliable References:
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• Parent’s name:
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• Phone:
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• Daughter’s name:
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• Reason:
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• Eligible to redate?
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• Relationship ended
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Special Note: If accepted, there is a $50 deposit per date. Forfeited if her return is even 1 minute late. If over 30 minutes late, refer to question #5.
Dad’s Use Only
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