EXPLORER ADMISISON FORM

Print this whole page, fill out the information below and then call 817-297-2276 to scheldule an appointment. (Please bring this completed print out with you to your first introductory lesson.)

 

Name______________________________(M /F) DOB_____________ Age______

Address____________________________ City ____________State_____ Zip__________

Home Phone____-______-________ Do you plan to move from the above address? _______

If yes, When?_____________

How long have you been interested in the Police department? ______________

Have you ever trained as an explorer in the past? _________If so, when and for how long? _____________

Do you have any health problems or physical limitations?______If so, please explain

Are you involved with any other community or volunteer work?

In a 3 sentences, please explain your expectations and or long time goal?

 

____________________________________________

Check all that apply. Why are you interested in becoming an Explorer? ___Authority ___Self Discipline ___Benefit your Community ___School Credit Other______________

HOW DID YOU FIND OUT ABOUT OUR EXPLORER PROGRAM? ___Internet ___Ad in Paper ___Crowley City Council ___Crowley Chamber of Commerce_______ ___Flyer ___Refferral. Who may we thank?___________ Other____________________