EXPLORER APPLICATION

Personal Information:

(example: A1234567 - CA)

PARENTAL INFORMATION

Mother's Information:

Father's Information:

Legal Guardian's Information:

EMERGENCY CONTACT INFORMATION:

Emergency Contact #1

(Relative or close friend/neighbor not listed above)

Emergency Contact #2

(Relative or close friend/neighbor not listed above)

MEDICAL INFORMATION

PERSONAL HISTORY:

PERSONAL REFERENCES

References (Must be completed- Include names of teachers, coaches, neighbors and friends)

Personal Reference #1

Personal Reference #2

Personal Reference #3

Personal Reference #4

AUTOBIOGRAPHY: