bluebird of bitterness

Name:___________________________________________

Stage name:_______________________________________

Agent: ___________________________________________

Attorney: _________________________________________

Therapist: _________________________________________

Number of therapy sessions per week:___________

Name of drug connection in case of medical emergency:

_________________________________________________

Sex: [ ] Male [ ] Female [ ] Formerly Male [ ] Formerly Female [ ] Both
[ ] Other________

If female, indicate breast implant size: ________

Will the size of your implants hinder your ability to safely operate a motor vehicle? [ ] Yes [ ] No

Hair color:

Males: [ ] Blonde [ ] Red [ ] Black [ ] Brown [ ]Other _________

Females: [ ] Blonde [ ] Platinum Blonde [ ] Ash Blonde [ ] Strawberry Blonde

Teenagers: [ ] Red [ ] Orange [ ] Green [ ] Purple [ ] Blue [ ] Fuchsia [ ]Teal [ ]Combination [ ]Skinhead [ ] Other________

Activities you perform while driving (check all that apply):

[ ] Eating

[ ] Drinking Starbucks coffee

[ ] Applying makeup

[ ] Shaving

[X] Talking on the phone (already checked for your convenience)

[ ] Lifting weights

[ ] Applying cellulite treatment to thighs

[ ] Tanning

[ ] Snorting cocaine

[ ] Watching TV

[ ] Reading Variety

[ ] Surfing the net

Medications you are taking:

[ ] Prozac

[ ] Zovirax

[ ] Lithium

[ ] Zanax

[ ] Valium

[ ] Medical marijuana

[ ] Zoloft

[ ] Viagra

[ ] Estrogen

[ ] All of the above

[ ] None of the above

If none, please explain: ___________________________________

Length of daily commute:

[ ] 4 hours or longer

[ ] 3 hours

[ ] 2 hours

[ ] 1 hour

[ ] less than 1 hour

If less than 1 hour, please explain:

______________________________________________________

If you are the victim of a carjacking, you should:

[ ] Call the police to report the crime.

[ ] Call Channel 9 News to report the crime, then watch your car on the news in a high-speed chase.

[ ] Call your attorney and discuss lawsuit against cellular phone company for your 911 call not going through.

[ ] Let them shoot you since law-abiding citizens are not permitted to carry a gun.

In the event of an earthquake, you should:

[ ] Stop your car.

[ ] Keep driving and hope for the best.

[ ] Use your cell phone to call your loved ones.

[ ] Pull out your video camera and obtain footage for Channel 9.

In the event of rain, you should:

[ ] Never drive over 5 MPH.

[ ] Drive twice as fast as usual.

[ ] Drive as close to the curb as possible to help spread the water onto sidewalks and pedestrians.

[ ] Stop traffic to raise convertible top.

When you see a driver with her arm extended out the window, it means:

[ ] Her turn signals are broken.

[ ] She intends to change lanes.

[ ] She’s drying her nails.

Automatic door locks are good for:

[ ] Security

[ ] Convenience

[ ] Messing with the heads of people trying to get in

The “bright” setting on your headlights is for:

[ ] Poorly lit roads at night

[ ] Flashing to get the car ahead to move out of the way

[ ] Revenge

When stopped by police, you should:

[ ] Pull over and have your driver’s license and insurance form ready.

[ ] Try to outrun them.

[ ] Have your video camera ready and provoke them to attack, thus ensuring yourself a hefty legal settlement.

This entry was posted on Friday, February 3rd, 2012 at 11:42 am and is filed under circus of life. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.