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Redneck Census Form

Redneck Census Form

Last name: ________________

First name:
(Check appropriate box)
[_] Billy-Bob
[_] Bobby-Sue
[_] Billy-Joe
[_] Bobby-Jo
[_] Billy-Ray
[_] Bobby-Ann
[_] Billy-Sue
[_] Bobby-Lee
[_] Billy-Mae
[_] Bobby-Ellen

Age: ____ (if unsure, guess)

Sex: ____ M _____ F _____ Not sure

Occupation:
[_] Farmer
[_] Mechanic
[_] Hair Dresser
[_] Waitress
[_] Un-employed

Spouse's Name: __________________________
2nd Spouse's Name: __________________________
3rd Spouse's Name: __________________________
Lover's Name: __________________________
2nd Lover's Name: __________________________

Relationship with spouse:
[_] Sister
[_] Aunt
[_] Brother
[_] Uncle
[_] Son
[_] Daughter
[_] Cousin
[_] Pet

Number of children living in household: ___
Number of children living in shed: ___
Number of children that are yours: ___

Mother's Name: _______________________
Father's Name: _______________________(If not sure, leave blank)

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

Do you [_] own or [_] rent your mobile home? (Check appropriate box)

Vehicles you own and where you keep them:
___ Total number of vehicles you own
___ Number of vehicles that still crank
___ Number of vehicles in front yard
___ Number of vehicles in back yard
___ Number of vehicles on cement blocks

Number of road kills presently in your freezer?
[ ] 3
[ ] 5
[ ] 10 or more

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

Newspapers/magazines you subscribe to:
[_] The National Enquirer
[_] The Globe
[_] TV Guide
[_] Rifle and Shotgun

___ Number of times you've seen a UFO
___ Number of times you've seen Elvis
___ Number of times you've seen Elvis in a UFO

How often do you bathe:
[_] Weekly
[_] Monthly
[_] Not Applicable

How many teeth? ___
Color of teeth:
[_] Yellow
[_] Brownish-Yellow
[_] Brown
[_] Black
[_] N/A

Brand of chewing tobacco you prefer:
[_] Red-Man

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

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