Bolton Fire Dept : Post 832 : Application

Explorer Post 832

Application

Name:____________________________________

Date of Birth: ______________

Age: _______

Address: _________________________

Town: _________________

State: ______

Zip Code: __________

Phone: _______________

Email: _____________________________________

School: ____________________________________

Highest Grade Completed: __________________

Medical History (if Any): ______________________________________________________________________

Allergies: _________________________________________________________________________________

Daily Medications: ___________________________________________________________________________

Hobbies: ______________________________________	Sports: _______________________________________
Pets: _________________________________________	Interests: ______________________________________
Future Career Goals: _____________________________	Fears: ________________________________________

Any other information you would like us to know: ______________________________________________________

____________________________________________________________________________________________

Reason(s) why you would like to join this program: _____________________________________________________

____________________________________________________________________________________________

Mother: _______________________________________	Occupation: __________________________________
Phone (H): _____________________________________	Work/Cell: ___________________________________
Father: ________________________________________	Occupation: __________________________________
Phone(H): ______________________________________	Work/Cell: ___________________________________

Other:

Name: ________________________________________	Relation: _____________________________________
Occupation: ____________________________________	Phone: ______________________________________

Will Parents or Guardian be able to attend monthly meetings? _____________________________________________

If under 18 years of age need parent's permission.

I _______________________________________ give my son/daughter ___________________________________ permission to joing and take part in training with the Bolton Fire Department Explorer's Program. Knowing that this document is an applicationa ONLY and an interview process will be set up to determine qualified candidates. By signing below I indicat that all of the above information is true to the best of my knowledge.

Parent/Guardian Signiture: ____________________________________________	Date: _________________
Candidates Signiture: ________________________________________________	Date: _________________