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APPLICATION TO DATE MY CHILDREN

PARENTS: Kevin & Deb Hentges

 

 

Name: (Last)__________________________First:____________________MI_______

 

Address:_______________________________________________County:___________

 

Religion:__________________________#of attendances last year?_________________

 

Parents: Father Name_______________________#of marriages________Years_______

 

Fathers Address_________________________________Phone #___________________

 

Mothers Name_______________________#of marriages________Years_______

 

Mothers Address________________________________Phone#____________________

 

  1. Do you drive a van? (If yes, discontinue filling out form. Good-Bye)
  2. In 50 words or less describe what NO means to you.___________________________

________________________________________________________________________
________________________________________________________________________

  1. In 50 words or less describe what LATE means to you________________________

________________________________________________________________________

  1. What hospital do you prefer for a DNA & Blood Test?_________________________
  2. Which is the last bone you want broken?___________________________
  3. Have you ever been shot before?__________________________________
  4. What do you want to be if you grow up?_________________________
  5. Do you have life insurance?_________________Amount?___________________
  6. The place for a woman is……____________________________________________
  7. What is my daughters name?_________________________________
  8. Who besides God should you fear most?____________________________
  9. Drivers License number_______________________#of points left on License______

13. Do you have a will?________________________Name of beneficiary_______________

 

Parental use only:

 

Appearance: Most looks like:   Circle one                                       STATUS:

 

  • Barney Fife                                                                             Call Police Now
  • Sponge Bob                                                                            Accepted
  • David Letterman                                                                     Rejected
  • Pee-Wee Herman                                                                    Pending
  • Al Gore                                                                                   Call Hit-Man