Please try to complete dis as best as you can.

Last name:________________________________________ [if your last Name no fit, continue on da other side of da page.]

First name:
[ ] Junior
[ ] Junior Boy
[ ] J.B. (short for Jr. Boy)
[ ] Honey Girl
[ ] Tita
[ ] Sistah
[ ] Braddah
[ ] Sistah-Girl

Sex: [ ]M [ ]F [ ]Mahu [ ]None

Slippah size____ Left ____ Right

Weight:
[ ]Shmall kind
[ ] Mejum
[ ] Shmall kind big
[ ] Momona

Eyes:
[ ] Blind as one bat
[ ] Bad, but not dat bad
[ ] She go!
[ ] Black and Blue

Occupation:
[ ] Construction workah
[ ] Sanitation Engineer
[ ] Surfah
[ ] Lei greeter
[ ] Waitress
[ ] Stripper
[ ] Un-employed
[ ] Bishop Estate Trustee

Spouse's Name: ______________________________
2nd Spouse's Name: __________________________
3rd Spouse's Name: __________________________
Lover's Name: _______________________________
2nd Lover's Name: ___________________________

Nationality:
[ ] Hawaiian
[ ] Popolo
[ ] Japanee
[ ] Filipino
[ ] Haole
[ ] Portagee if yes; explain why:
[ ] Pake if yes; explain why:
[ ] All da above

Numbah of children living in household: ____________

Numbah of children living in your household das not yours: _____

Numbah of children thats buming off of you das over 23 years old: _______

Mother's Name:______________________(Relation__________)
Father's Name:_______________________(Relation__________)

Edumacation: 1 2 3 4 (Circle highest grade completed)

What year you wen grad: ____ (if unsure, try guess)

If you obtained one higher edumacation what was your major?
[ ]5th grade [ ] 6th grade

Cawheelas you own and where dey stay:
___ Total number of cawheelas you own
___ Numbah of cawheelas that still crank ovah
___Numbah of cawheelas wit rust
___ Numbah of cawheelas no mo rust
___ Numbah of cawheelas on cement blocks
___ Numba of cawheelas stay held together with duct tape.

Age you started fo drive ______ (If over 10 slow learner ?)
[ ] Yes[ ] No

Do you have a surf rack? [ ] Yes [ ] No;
If no, please explain:

Color of teeth:[ ] Yellow [ ] Brownish-Yellow[ ] Brown [ ] Black [ ] N/A

How far is your home from a paved road?
[ ] 1 miles
[ ] 2 miles
[ ] don't know

Distance between you and da beach? ______

Do you live on beach front property but you don't own a house or the land? Please explain:

How many times have you gotten away with a DUI this year because you were related to da policeman? ____

How much beer do you drink a day? [ ] 6 pack [ ] 12 pack [ ] 18 pack [ ]case

How do you know that you had too much to drink?
[ ] You fall out of da car when da policeman opens da ca door.
[ ] Da keg is empty.
[ ] You Haole but your eyes look like de from one Japanee.
[ ] When you piss, da bugga smell like Budweiser.
[ ] All of the above.