THERESA’S BOYFRIEND APPLICATION FORM

To be completed by all applicants prior to first interview.

Section 1 – You

Name: _______________________ Actual Age: _____________ Mental Age: __________

Height: ________m Weight: _______kg IQ Level: ________

Current Account Balance: R__________ Credit Cards Held: ________________________

Vehicle Driven: ________________________ Estimated Value: _________________________

Section 2 – Your Needs

Do you expect to have home cooked meals prepared on a regular basis? Yes / No

When asked to “Go Shopping” are you able to undertake the task without groaning? Yes / No

Please answer the following: Saturday Afternoon is for: Shopping / Sport / Sleeping

Section 3 – Your History

Have you been married before? Yes / No If Yes for how long? _____ Years ____ Months

Have you been dumped or received one or more “Dear John” Letters in the last 2 years? Yes / No

When you were dumped (yes we know you were) how long ago was this? ____ Years ___ Months

Have you ever been caught wearing your previous girlfriends clothing? Yes / No

If you answered Yes to the previous question have you ever been arrested? Yes / No

Can you cook? Yes / No (Note: Boiling an egg does not constitute cooking)

Section 4 – Honesty

Have you ever lied on an application form? Yes / No If Yes are you known to be stupid? Yes / No

Your Girlfriend wants Italian Food and You want a Big Mac and Fries, who wins? You / Her

Section 5 – Health

Is your general state of health good? Yes / No Do you take Drugs? Yes / No

If you take Drugs are they Recreational Drugs? Yes / No or Performance Enhancing Yes / No

If Performance Enhancing what type? ______________ (Note: Viagra is Performance Enhancing)

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Section 6 – Obedience

Have you been complimented on your gentlemanly behaviour in the past? Yes / No

If you answered Yes was the compliment from your own mother? Yes / No

If your Girlfriend tells you NOT to do something do you take heed and comply with her? Yes / No

You have a choice to see your Girlfriends friends’ new baby or go to a bar which? Baby / Bar

Section 7 – Supporting Information

Here you may add any extra information supporting your application to join the “Theresa’s Boyfriend Waiting
List” – Please be aware that you may use either block capitals or real joined-up writing like mummy and
daddy do (if you can).

Section 8 – Declaration

I declare that the above answers and information are true and if at a later date my answers are found to either
factually incorrect or even outright lies, I accept that Theresa, her friends and in fact anyone she knows on
planet earth can advise any or all of my friends or new girlfriends that I’m the biggest fart on earth.

Signed: _____________________________________ Dated: ___________________________