User:Rlevse/Application to date my daughter
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| style="padding: 1em 1.5em 1.5em 1.5em;" | Personal Information {| cellspacing="0" cellpadding="0" style="border-collapse: collapse;" style="width: 100%; margin: 0; border: 0; background-color: transparent;" |
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| style="border: 0; border-bottom: 1px solid #ccc; width: 12em;" | Name: | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc; text-align: right; width: 6em;" | Age: | style="border: 0; border-bottom: 1px solid #ccc; width: 6em;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: center;" colspan="2" | Last, First, Middle | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; width: 12em;" | Address: | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: center;" colspan="2" | Street, City, State | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: left;" | Religion: | style="border: 0; border-bottom: 1px solid #ccc; width: 6em;" | | style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | Church: | style="border: 0; border-bottom: 1px solid #ccc; width:20em;" | | style="border: 0; border-bottom: 1px solid #ccc; width:16em; text-align: right;" | Times attended last year: | style="border: 0; border-bottom: 1px solid #ccc; width: 6em;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: left;" | Wikipedia edit count: | style="border: 0; border-bottom: 1px solid #ccc; width: 6em;" | | style="border: 0; border-bottom: 1px solid #ccc; width: 16em; text-align: right;" | Commons edit count: | style="border: 0; border-bottom: 1px solid #ccc; width: 6em;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: left; width: 12em;" | Administrator? | style="border: 0; border-bottom: 1px solid #ccc; text-align: center; width: 6em;" | Yes/No | style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | Arbiter? | style="border: 0; border-bottom: 1px solid #ccc; text-align: center; width: 6em;" | Yes/No | style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | Founder? | style="border: 0; border-bottom: 1px solid #ccc; text-align: center; width: 6em;" | Yes/No | style="border: 0; border-bottom: 1px solid #ccc; text-align: right; width: 16em;" | Number of Sockpuppets: | style="border: 0; border-bottom: 1px solid #ccc; text-align: center; width: 6em;" | |
Family Information
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| style="border: 0; border-bottom: 1px solid #ccc; width:12em;" | Father’s Name: | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc; width:12em; text-align: right;" | # Marriages: | style="border: 0; border-bottom: 1px solid #ccc; width: 6em;" | | style="border: 0; border-bottom: 1px solid #ccc; width:16em; text-align: right;" | # Years: | style="border: 0; border-bottom: 1px solid #ccc; width: 6em;" | |
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| style="border: 0; border-bottom: 1px solid #ccc;" | Address: | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc;" | Mother’s Name: | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | # Marriages: | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | # Years: | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc;" | Address: | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | |
Non-Optional Questions
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| style="border: 0; border-bottom: 1px solid #ccc;; text-align: right;" | 1. | style="border: 0; border-bottom: 1px solid #ccc;" | Do you own or drive a "van"? Yes/No | style="border: 0; border-bottom: 1px solid #ccc; width: 50%;" | (If yes, disregard the remainder of this form) |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | 2. | style="border: 0; border-bottom: 1px solid #ccc;" | In 50 words or less, describe what "no" means to you: | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; width:100%;" colspan="3" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | 3. | style="border: 0; border-bottom: 1px solid #ccc;" | In 50 words or less, describe what "late" means to you: | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | 4. | style="border: 0; border-bottom: 1px solid #ccc;" | Where would you least like to be shot? | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | 5. | style="border: 0; border-bottom: 1px solid #ccc;" | Which is the last bone you want broken? | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | 6. | style="border: 0; border-bottom: 1px solid #ccc;" | What do you want to be if you grow up? | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | 7. | style="border: 0; border-bottom: 1px solid #ccc;" | Complete this sentence: | style="border: 0; border-bottom: 1px solid #ccc;" | “A woman’s place is _______________________” |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | 8. | style="border: 0; border-bottom: 1px solid #ccc;" | What is my daughter’s name? | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | 9. | style="border: 0; border-bottom: 1px solid #ccc;" | Who, besides God, should you fear most? | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; text-align: right;" | 10. | style="border: 0; border-bottom: 1px solid #ccc;" | List Three Reliable References: | style="border: 0; border-bottom: 1px solid #ccc;" | |
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| style="border: 0; border-bottom: 1px solid #ccc; width:100%;" colspan="3" | |
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| style="border: 0; border-bottom: 1px solid #ccc;" | • Parent’s name: | style="border: 0; border-bottom: 1px solid #ccc; width: 12em;" | |
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| style="border: 0; border-bottom: 1px solid #ccc;" | • Phone: | style="border: 0; border-bottom: 1px solid #ccc; width: 12em;" | |
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| style="border: 0; border-bottom: 1px solid #ccc;" | • Daughter’s name: | style="border: 0; border-bottom: 1px solid #ccc; width: 12em;" | |
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| style="border: 0; border-bottom: 1px solid #ccc;" | • Reason: | style="border: 0; border-bottom: 1px solid #ccc; width: 12em;" | |
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| style="border: 0; border-bottom: 1px solid #ccc;" | • Eligible to redate? | style="border: 0; border-bottom: 1px solid #ccc; width: 12em;" | |
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| style="border: 0; border-bottom: 1px solid #ccc;" | • Relationship ended | style="border: 0; border-bottom: 1px solid #ccc; width: 12em;" | |
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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| style="border: 0; border-bottom: 1px solid #999;" | Looks Like | style="border: 0; border-bottom: 1px solid #999;" | | style="border: 0; border-bottom: 1px solid #999;" | Status |
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| style="border: 0; border-bottom: 1px solid #ccc;" | Brad Pitt | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | No Way |
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| style="border: 0; border-bottom: 1px solid #ccc;" | David Letterman | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | Rejected |
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| style="border: 0; border-bottom: 1px solid #ccc;" | Pee-wee Herman | style="border: 0; border-bottom: 1px solid #ccc;" | | style="border: 0; border-bottom: 1px solid #ccc;" | Maybe |
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