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Racine Police Explorer Post 286
Our Post Patch
Last Name
First Name
Middle Name
Age
Date of Birth
     
Street Address
Apartment Number
City
State
Zip Code
Home Phone
Second Home Phone
Work Phone   X  
Moble Phone
Pager
E-Mail Address
     
School of Attendence
Grade
Hours of Attendence
Counsalor
Parents/Gardians Name
     
List your long-term educational or vocational goals:
Do you belong to any other organizations (youth, civic, school, or scouting)?
List hours/days they meet
Have you completed any other specialized training which would help you as a member of Explorer Post 286? List any:
What do you have to offer to Explorer Post 286, as an individual?
Have you ever been mentioned as an offender or charged as an offender in any criminal act?
     
Please number these in order from most to least interest
 Camping    Shooting     Seminars    Law Enforcement    Bowling
 Sports    First Aid     Picnics    Rescue
     
How Did You Find Out About Us?   (Check All That Apply)
 Friend     Councler    Family     Poster    Police Officer
Refrence's Name #1
Refrence's Name #2