Love Contract

Ladies, copy, paste, and print. LOL!

Dating Application



Name ________________ ______________ ___________

Last First Middle

Address __________________________________________________

City _________________________ State_____ Zip___________

Home .. _________________ Cell.. __________________


Do you live with any of the following: (circle)

Grandmother Parents Mother Father

Girlfriend Baby Mama Alone Nowhere

Wife Auntie Other _________________


Weight _______ Height ________

Ethnicity: Black Hispanic White Other_________________


Date of Birth ______________ Age ____

SS.. _____-___-_________


Any Children (circle yes or no) yes no
If yes, how many _______

How many Baby Mamas? _________

If more than one, please name below. Use separate sheet of paper if
need more room.

1.
_____________________________________________________________

2.
_____________________________________________________________

3.
_____________________________________________________________



Ever been married (circle ) yes no
If yes, how many times? _______


Are you or have you ever been on the Down Low? (circle one)

Yes No

Do you owe child support? (Circle one) Yes No Don’t Know

*If your ex is getting state benefits (childcare, food stamps, etc),
then you owe somebody something. Especially tax payers.
Stop here and go take care of your damn kids.


*Please use a separate sheet of paper to compile a list of goals and
accomplishments.

Did you graduate from high school? (circle one) yes no

Name of high school (if yes)
__________________________________________________________


Have you received any of the following? (Circle One)


GED Diploma Nothing

*If you did not complete any of the above, please stop here and
return
to school.


Any college? (circle one) Yes No Still Enrolled Graduated


Have you ever been to jail? (circle one) Yes No

If yes, what for? (be very detailed)


____________________________________________________________________
_______
____________________________________________________________________
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____________________________________________________________________
________
____________________________________________________________________
________
____________________________________________________________________
________
____________________________________________________________________
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____________________________________________________________________
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____________________________________________________________________
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____________________________________________________________________
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____________________________________________________________________
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________________________________________________________________



Have you ever been to prison? (circle one) Yes No

*If you have answered yes to the above question, please STOP HERE
and
call your P.O. immediately.


Employed? (circle) yes no

*If no, please stop here?

If yes, where and how long?
____________________________________
_______________________________________________________________

_______________________________________________________________


Do you have heath insurance? Yes No

When did you last visit the dentist? ______________________________

When was the last time you have been to the doctor?
__________________

What for? ______________________________________________________

_______________________________________________________________

_______________________________________________________________

List any (all) illnesses. Use separate sheet of paper if needed.
__________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________


Do you have or have you had any of the following? (please circle all
that may apply)

Hep A Hep B Hep C Herpes Mononucleosis

HIV/AIDS The Bird Flu Bunions

West Nile Virus Crabs Chlamydia Gonorrhea

SARS Head Lice Ringworms Boils A cold

Sex Change Shingles Something that you can’t spell

Meningitis Measles Mumps Ebola Virus


*If you have circled any of these, do NOT turn in your application.
See the doctor immediately and leave me the hell alone.


Do you or have you ever used (ingested in any way) any of the
following: (circle all that apply)

Crack/Cocaine Heroin Paint Markers Ecstasy

Glue Bad pills Snuff Anything under the kitchen sink


By signing below, you agree that all of the information given above
is
true to the best of your knowledge. For my protection, you may be
asked to
provide the following information upon request: state ID, birth
certificate, recent payroll stub, a recent clean bill of health from
a certified
physician or practitioner. Falsifying information may result in
termination of this relationship (if applicable), and a severe ass
whooping by my
project cousins Pookie, Ray-Ray, Darnell, Lil Krazy or all of the
above.



Applicants Signature
______________________________________________________________



Print Name
_______________________________________________________________


DATE…………………