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Joke Form Sample © R. Craig Collins, 2005/13

The following form actually works

Application to date my daughter

NOTE: The application will be rejected forthwith unless accompanied by a photo ID, a complete financial statement, job history,
medical report signed by your doctor, and FBI/SEC background check.

Application's Name:

Application's e-mail:

Date of Birth:

Height: ft. in.

Weight: lbs.

Home Address:
How Long at this Address

Social Security Number:

Driver's License:

Net Financial Worth In Thousands: $

IQ:

GPA

Highest Boy Scout Rank Obtained:

Do you have one at least one parent or guardian? Yes No
Are they Human? Yes No

When is the best time to Interview your parent or parole officer?

Do you have:
Earrings(s) Nose Ring Navel Ring No Rings

If anything aside from 'No Rings' is checked, QUIT now!

Do you have a van? Yes No
Do you have a pickup with a a topper? Yes No

In 25 words or less, describe what 'late' means to you.

In 25 words or less, describe what 'Abstinence' means to you.

Do you understand what it means when I say to you,
'Touch my daughter and I'll rip your head off.'? Yes No

Answer the following questions by filling in the blanks, answer freely, all answers will be kept confidential.

    If I were shot, the last place I would want to be wounded is the
    If I were beaten, the last bone I would want to broken is the
    The strongest beverage I have ever drunk is
    One question I hope this application does not ask is
    When I first meet a girl, the first thing I notice about her is
    (If the answer to the above question starts with a 'T', 'B', or 'A',
    discontinue filling out the application.
    I would advise leaving now, with head low and running in a serpentine fashion).

    What do you want to be if you grow up?

I hereby swear the above information is true, to the best of my knowledge, and I do consent to any further test to which you may wish to subject me. (Including, but no limited to: lie detector, Chinese water torture, red hot pokers applied vigorously, and burial up to my neck in sand next to a red ant colony.)


Samples of Code used

<form action="http://url/cgi-bin/FormValues.asp" method="post">

Application's e-mail:
<input type="text" name="email" size="30">

Date of Birth:
<SELECT>
<OPTION SELECTED VALUE="Jan">Jan
<OPTION VALUE="Feb">Feb
<OPTION VALUE="Mar">Mar
<OPTION VALUE="Apr">April
<OPTION VALUE="May">May
<OPTION VALUE="Jun">June
<OPTION VALUE="Jul">July
<OPTION VALUE="Aug">Aug
<OPTION VALUE="Sep">Sept
<OPTION VALUE="Oct">Oct
<OPTION VALUE="Nov">Nov
<OPTION VALUE="Dec">Dec
</SELECT>

Driver's License:
<input name="dl" size="8"
maxlength="8">

Highest Boy Scout Rank Obtained:
<SELECT
name="rank"
SIZE="3">
<OPTION VALUE="1">4F
<OPTION VALUE="2">Cub
<OPTION VALUE="3">Webelo
<OPTION SELECTED VALUE="4">Scout
<OPTION VALUE="5">Explorer
<OPTION VALUE="6">Eagle
</SELECT>

Are they Human?
<INPUT TYPE="RADIO" Name="human" Value="True"
CHECKED>Yes
<INPUT TYPE="RADIO" Name="human" Value="False">
No

Do you have:
<INPUT TYPE="checkbox" Name="earring">
Earrings(s)
<INPUT TYPE="checkbox" Name="nosering">
Nose Ring
<INPUT TYPE="checkbox" Name="navalring">
Navel Ring

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

<input type=submit value="Submit Request"><input type=reset value="Clear Form">