Jerry Springer Show Application

Last name: ________________

First name: (Check appropriate box)
(_) Billy-Bob
(_) Billy-Joe
(_) Billy-Ray
(_) Billy-Sue
(_) Billy-Mae
(_) Billy-Jack

What does everyone call you?
(_) Booger
(_) Bubba
(_) Junior
(_) Sissy
(_) Other___________________

Age: ____ (if unsure, guess) _____ Not sure

Shoe Size: ____ Left ____ Right

Occupation: (Check appropriate box)
(_) Farmer
(_) Mechanic
(_) Hair Dresser
(_) Unemployed
(_) Dirty Politician
(_) Preacher
(_) Strip Dancer
(_) Hooker

Spouse’s Name:_________________________
2nd Spouse’s Name:______________________
3rd Spouse’s Name:______________________
Lover’s Name:___________________________

Relationship with spouse: (Check appropriate box)
(_) Sister
(_) Brother
(_) Aunt
(_) Uncle
(_) Cousin
(_) Mother
(_) Father
(_) Son
(_) Daughter
(_) Pet

Number of children living in household: _____
Number of children living in shed: ______
Numbers that are yours: ______
Mother’s Name: _______________________
(If not sure, leave blank)
Father’s Name: _______________________
(If not sure, leave blank)

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

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: ___

Do you have a gun rack?
If no, please explain:

Newspapers/magazines you subscribe to:
(_) The National Enquirer
(_) The Globe
(_) TV Guide
(_) Soap Opera Digest
(_) Rifle and Shotgun

Number of times you’ve seen a UFO:_____
Number of times in the last 5 years you’ve seen Elvis:_____
Number of times you’ve seen Elvis in a UFO:_____

How often do you bathe:
(_) Weekly
(_) Monthly
(_) Not Applicable

Colour of eyes:
Right_____ left_____

Colour of hair:
(_) Blond
(_) Black
(_) Red
(_) Brown
(_) White
(_) Clairol

Colour 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
(_) Just a whoop-and-a-holler!
(_) road?

SHOW ANNOUNCEMENT: Jedi Springer Now available on Earth channels!

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11 thoughts on “Jerry Springer Show Application

  1. Deeps… again it takes one to know one huns *winks*

    Glaize rofl you are tff

    Donstuff oooo Mixed colours for the toofs yers I forgot about those! We have that here as well those mostly the trend is no two front teeth… Apparently it is better, for what I don’t know.

  2. Don’t laugh… I filled in this application for my family to go on the show. Apparently we were turned down for being TOO Dysfunctional! Damn it. Also, none of us would get naked and do mud wrestling either… ewww…

  3. What do you mean… no naked and mud wrestling? I saw a photo of this very thing in the family photo album! Oh shit that was mine! Dang … ok listen it was NOT me, no, seriarsely now it wasn’t. I think I will have to speak to Jerry for you and get him to give you guys a special pass. Hmmm yes

    When last did you shoot a pellet gun?

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