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 Jerry Springer Guest

jerry springer show, redneck tv

Personal Information:

Name___________ Wut uthers calld you ______________

Can U Remember Ure Last Name?

___Yup ___Nope

Can You Spell Your Last Name?

___Yup ___Nope

CB Handle___________

Yore Mama's Name______________

Yore Daddy Name(if known)________________

Spouse's (husband or wife) Name_________________

Other Spouse ______ Dead Spouse ___________

Relationship to spouse:

___Sister ____Brother ____Mother ____Father
___Pet ___Aunt ___Uncle


___Unemployed / Mechanic ___Gun Dealer ___Hair Dresser

___Skinhead ___ Street Walker ____Waitress ___ Exotic Dancer

Number of Children in Household ___ Number of Children in the Shed ___

Do you know how many are yours? ___ Yup ___ Nope ____Don't Care

Circle Highest Level of Education: 1 2 3 4

How Far is Your Mobile Home
from the nearest paved road:

___ 1mile __ 5 miles ___ more

Number of Times You Have Survived a Tornado: ___

Number of Vehicles Owned___
How many trucks?___

How many in the front yard?___ How many in the Back Yard?___

How many run?___ How many on Cement Blocks?___ Do you have a gun rack in your truck? ___Yup ___Nope If Nope, why not?_______________

Truck Equipment: ___Gun Rack ___Pit Bull
___Spit Cup ___Fuzzy Dice ___Rebel Flag ___Naked Woman Mud flaps ___NRA sticker

Weapons Owned: ___Tire Iron ___Pick Handle
___Beer Bottle __Shotgun

Number of Dogs Owned: ___

Jerry Springer too hot for Television

Number of Homemade Tattoos: ___

Which of the Following Appliances are
in your Front Yard?

___Friggerator ___Heatin Stove ___Warsher

___TV ___Freezer

How Many of the Above Appliances Work: ___

Fav-o-rite Recreation:

___Drinkin ___Cow Chip Throwin ___Possum Huntin ___Crawdad Huntin

___Spittin Backy ___Scratchin ___Watchin Wrasslin

If You Can Read, Which Magazines Do You Prefer:

___Soap Opera Digest ___Rifle and Shotgun ___NWA ___TV Guide ___National Enquirer ___True Confessions

Which Stinks Worse:

___Hogpen ___Outhouse ___Spouse

Have You Ever Stayed Sober for More Than

One Day: ___Yup ___Nope

Do You Know Any Words with More Than 4 Letters:

___Yup ___Nope

Can you count higher than the # of fingers you have left on your hands?

___Yup ___Nope

Which is Correct?:

___"I Seed Him" ___"I Did Seen Him" ____ "I don't know his name"

How Many Cartons of Cigarettes
Do You Smoke a Day? ___

Math Test: How Many Food Stamps
Do the Following Cost?

___Six Pack ___Ciggies ___Shotgun Shells
___Backy ___Prostitute

Number of Times You've Seen:

 ___A UFO ___ Elvis ___Elvis in a UFO

Health Questionnaire: Which of the
Following Do You Have?

___Head Lice ___B.O. ___Crabs ___Runny Nose ___Boils

Can You Remember the Last Time
You Bathed?

___Yup ___Nope

What color are your teeth?
___Yellow ___Brown ___Black ___N/A

Circle How many teeth you have 1 2 3 4 5 6 Nun

Fav-o-rite Recreation:
__ Drankin' __ Cow Chip Throwin' __ Possum Huntin' __ Crawdad Huntin'
__ Spittin' Backy __ Scratchin' __ Watchin Wrasslin'

I hereby swear this is the trooth and signd my "X" on   ______/________200__

I was at the airport, checking in at the gate when an airport employee asked, "Has anyone put anything in your baggage without your knowledge" To which I replied, "If it was without my knowledge, how would I know" He smiled knowingly and nodded, "That's why we ask." - Happened in Birmingham , Ala

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