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  1. Gender*
  2. Please add the days of the week that you participate in these activities.

  3. Have you previously been part of Explorers or Public Safety Cadets?*
  4. PARENT(S)/GUARDIAN(S)
  5. EMERGENCY CONTACT
  6. I hereby grant to the City of Palestine, Palestine Police Department, and Youth Corps Unit $1871 the right to use any photographic image of myself.  I understand that the City of Palestine, Palestine Police Department, and the Youth Corps Post #1871 will utilize these images for the non-profit, governmental purpose of communicating public information regarding city and department services, programs, and facilities.  I also understand that I release any claim, right, or title to said photographs or images.

  7. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  9. This field is not part of the form submission.