Please Note: This form was designed by Jimmy Coupe, an 8th grade student in 1996, as part of a special project. Thanks, Jimmy!



What is name your

What is your e-mail address (if you don't have one use your teachers)

City/town

State/Province

Country




  • What is your favorite number:

  • What is your Sex: Male Female

  • What is your Age:

  • Are you: Right Handed Left Handed Ambidextrous

  • Are your ear lobes: Attached unattached

  • Are you double jointed in the hands*: Yes No

  • Can you roll your tongue: Yes No

  • Do you have a Hitch-Hickers thumb: Yes No

  • Can you flip your tongue: Yes No

  • Any other wierd tongue tricks: No

  • Any other double joints: No

  • Is your index finger longer than your middle: Yes No

  • Is your little finger bent: Yes No

  • Can you taste the cemicalized paper: Yes No

  • Are you colorblind: Yes No

  • What is your dominate eye: Left Right

  • Do you have a widow's peak: Yes No

  • Are you: Left orRight thumbed

  • What arm is on the top when you fold them: Left Right

  • What blood type are you: A B AB O ?

  • HeightCM/CM Span




    What is your heart rate (resting)
    What is your heart rate (medium exercise)
    What is your vital capacity ML
    What is your foot sizeCM





    *=not including thumbs

  • Click here to get Back To TelGen Page


    Click here to get Back To Wizard's World


    back to MMS home page
    back to The Mendocino Community Network Home Page