Please try fo complete dis as best as you
can.
Last name:
_______________________________________
[if your last name no fit, continue on da oddah side of da page.]
First name:
[ ] Junior
[ ] Junior Boy
[ ] J.B. (short for Jr. Boy)
[ ] Honey Girl
[ ] Tita
[ ] Sista
[ ] Bradda
[ ] Sista-Girl
What year you went grad:
____
(if unsure, try guess)
Sex:
[ ]M
[ ]F
[ ]Mahu
[ ]None
Slippa size: ____ Left ____ Right
Weight:
[ ]Small kine
[ ] Mejum
[ ] Small kine big
[ ] Momona
Eyes:
[ ]Blind as one bat
[ ] Bad, but not dat bad
[ ] She go!
[ ] Black and Blue
Occupation:
[ ] Construction worka
[ ] Sanitation Engineer
[ ] Surfa
[ ] 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
[ ] Japanese
[ ] Filipino
[ ] Haole
[ ] Portagee if yes; explain why:
[ ] Pake if yes; explain why:
[ ] All da above
Numba of children living in household:
______
Numba of children living in your household
das not yours: _____
Number of children
that stay bumming off of you das over 23 years old: ______
Mother's Name:
_______________________(Relation__________)
Father's Name:
_______________________(Relation__________)
Edumacation: (Circle highest grade
completed)
1 2 3 4
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
___ Number of cawheelas that still crank ova
___ Number of cawheelas wit rust
___ Number of cawheelas no mo rust
___ Number of cawheelas on cement blocks
___ Number 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
don't own a house or the land? [ ] Yes [ ] No
Please explain:
How many times have you gotten away with a
DUI this year because you were related to da policeman?____
How much pakalolo do you smoke a day?
[ ] 1 joint
[ ] 2 joints
[ ] would smoke but cost more den gold.
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 car door.
[ ] Da keg is empty.
[ ] You Haole but your eyes look like de from one Japanese.
[ ] When you piss, da bugga smell like Budweiser.
[ ] All of the above.
