Ok, this scan looks really shitty, forgive me. This is what you have to write:
1. What is your name? And your blog name?
2. Blog URL
3. Write: the brown fox jumped over the lazy dog.
4. Favourite quote
5. Favourite song
6. Favourite band/singers
7. Say anything you want
8. Pass it along to a few bloggers
And that's it! Have fun with it! :)