2. Last Name
3. First Name
4. MI
6. Date of Birth
8. Home Address
10. Home Phone/Cell
12. Email Address
14. Height
15. Weight
16. Eye Color
18. Social Security Number
20. Parent/Guardian Name #1
22. Parent/Guardian #1 Contact Number: Cell/Work
24. Parent/Guardian Name #2
26. Parent/ Guardian #2 Contact Number: Cell/Work
28. School Attending
30. Grade
31. School ID
33. Allergies
35. Teacher/Police Reference
37. Contact Information
39. Why do you wish to become a Law Enforcement Explorer with the Buffalo Police Department?
41. Please describe yourself in one paragraph, stating the qualities that best identify you as an individual:
43. List clubs, sports, or employment that you are currently involved in:
45. List any other hobbies or interests:
47. Have you ever been arrested? If yes, please explain and include the date of arrest:
49. Have you ever used or experimented with drugs?
51. Are you affiliated with any gangs? If yes, explain:
53. Are you now, or have you ever been on probation or PINS?
55. List any physical or medical conditions you have that would prevent you from participating in physical exercises and training within the program:
57. Explorers are expected to participate in physical fitness exercise and activites. By signing the document you acknowledge that your child is in good physical health to participate and you are agreeable to it:
59. Guardian #1 Signature
60. Date
62. Guardian #2 Signature
63. Date
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field