2. 
3. Coon Rapids Police Explorer Application
5. Name:

   Full, Middle, Last

7. Date of Birth

   MM/DD/YYYY

9. Address:

   Enter your full street address here.

11. Home Phone:

    Enter your home phone here if you have one

12. Cell Phone:

    Enter your mobile number here

14. Email Address:
16. Current School:
17. Grade:
19. Father's Name:
20. Phone:
22. Mother's Name:
23. Phone:
25. I authorize the Coon Rapids Police Department to obtain a criminal history, driving record, and in house records check for the applicant listed above.
27. Applicant Signature:

    Type name to accept as signature

28. Date:
30. Parent Signature (If Applicant under age 18)

    Type name to accept as signature

31. Date:
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field