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Application For The Jerry Springer Show

  • 20-07-2004 6:33pm
    #1
    Kazu
    Closed Accounts Posts: 1,309 ✭✭✭


    APPLICATION FOR THE JERRY SPRINGER SHOW:

    Personal Information:
    Name___________ Nickname______________ CB Handle_____

    Yore Muma________Yore Diddy (if known)_______

    Spouse's Name_________ Relationship to spouse: ___Sister____Brother ____Mother ____Father ___Pet___Aunt ___Uncle

    Occupation: ___Unemployed Mechanic___Gun Show Dealer ___Skinhead

    Number of Children in Household___ Number of children that are yours___

    Circle Highest Level of Education: 1 2 3 4

    How Far is Your Mobile Home From a Paved Road?:
    ___1mi. __5 mi.?

    Number of Times You Survived a Tornader: ___

    Number of Vehicles Owned___ Number on Cement Blocks____

    Truck Equipment: ___Gun Rack ___PitBull ___Spit Cup ___Fuzzy Dice___Rebel Flag ___Naked Woman Mudflaps ___NWO and/or NRA sticker

    Weapons Owned: ___Tire Iron ___Pick Handle ___Beer Bottle ___Shotgun

    Number of Dogs Owned: ___ Number of Homemade Tattoos: ___

    Which of the Following Appliances are in your Front Yard?: ___Friggerator ___Heatin Stove___Warsher ___TV ___Freezer How Many of the Above Appliances Work?: ___

    Fav-o-rite Recreation: ___Drinkin___Cow Chip Throwin ___Possum Huntin ___Crawdad Huntin ___Spittin Backy___Scratchin ___Watchin Wrasslin

    If You Can Read, Which Magazines Do You Prefer?:
    ___Soap Opera Digest ___ Rifle and Shotgun ___NWO ___TV Guide ___National Enquirer___True Confessions ___Soldier of Fortune __Mini Trucker

    Which Stinks Warse?: ___Hogpen___Outhouse ___Spouse

    Can You Spell Your Last Name?:___Yup___Nope

    Can You Remember Your Last Name?:___Yup ___Nope

    Ever Stayed Sober for More'n a Day?:___Yup ___Nope

    Do You Know Any Words with More'n 4 Letters?: ___Yup ___Nope

    Which is Correct?: ___"I Seed Him" or ___"I Seen Him"

    How Many Cartons of Cigarettes Do You Smoke a Day?
    ___

    Math Test: How Many Food Stamps Do the Following Cost?
    ___Six Pack ___Ciggies ___Shotgun Shells ___Backy ___Prostitute

    Number of Times You've Seen: ___a UFO ___ Elvis ___Elvis in a UFO

    Health Questionaire: Which of the Following Do You Have? ___Head Lice ___B.O. ___Crabs___Runny Nose ___Boils

    Can You Remember the Last Time You Done Bathed?
    ___Yup ___Nope

    Color of Teeth: ___Yellow ___Brown___Black ___N/A

    I hereby swear this is the trooth and sign my "X" on _________19___


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