Application for Membership
St. Lucie County Sheriff’s Office Explorer Post 400
Junior Cadet Program
To Prospective Jr. Cadets and Parents:
In order to become a member of Sheriff’s Explorer Jr. Cadet Program, the following criteria
must be met:
Complete and return the following attached forms
_____ 1.
______ 2.
_____ 3.
_____ 4.
_____ 5.
_____ 6.
_____ 7.
Membership Application
Personal Data
Personal Health & Medical Summary Form
CO2 Training Permission/Release Form
Interest Survey Form
Include the required $20.00 Registration Fee
Attend Two Consecutive Post Meetings
To maintain your membership in good standing, you must attend 80% of all Jr. Cadet functions and
meetings, dues must be up to date (currently $1.00 per month), members must abide by all rules and
regulations governing Jr. Cadet Program.
Explorer Post 400 is sponsored by the St. Lucie County Sheriff’s Office, the area chartered by the
Learning for Life, Boy Scouts of America and is a member of the Florida Sheriff’s Explorer Association.
The purpose of the Post is to expose young people to the Law Enforcement community in a positive way.
This is done by a combination of training, limited exposure in the field and by interfacing with certified Law
Enforcement Officers.
For those young adults who are interested in a career in Law enforcement, there are several scholarship
programs available to qualified applicants.
Accident insurance for Jr. Cadet activities is provided through the Learning for Life, Boy Scouts of
America. The cost of this insurance is paid through registration fees.
Although this Post is sponsored by the St. Lucie County Sheriff’s Office, their activities are not funded by
the Sheriff’s Office. We strive to teach young people responsibility by having them earn the funds
necessary to support their activities through fund raising events. The amount of expenses that Post 400
will pay varies according to participation and funds available in their treasury.
Uniforms are initially provided at no cost to the Jr. Cadet by the St. Lucie County Sheriff’s Office;
however, replacement of lost or missing items must be absorbed by the individual they were released to.
If you have any questions or comments, please contact Deputy Sal Anicito,
Senior Advisor Post 400 (772) 871-5358 or FAX (772) 871-5355.
D.
MEMBERSHIP APPLICATION
Date_________
JC_________
Name: _______________________________ Nickname: _________________
Address: _____________________________________________________________
Street Address
City
State
Zip
Home Phone #: (_____)_________________ Cell Phone #: (______)____________
Age: ______ Date of Birth: _____________________Male/Female ______
What school do you attend? __________________________________ Grade: ______
Have you ever been suspended or expelled from any schools? ________________
If yes, give date, reason, and name of school: _________________________________
______________________________________________________________________
How did you hear about the JR. Cadet Program _______________________________
_____________________________________________________________________
Father’s Name: ________________________ Mother’s Name: ___________________
Work Phone #: (______)_________________ Work Phone #: (____)______________
Cell Phone #:
(______)_________________ Cell Phone #: (_____)______________
Jr. Cadet Application
Pg. 1
Personal Data:
This must be filled out completely.
Height: _________ Weight: _________ Hair Color: ____________ Eye Color: _______
Place of Birth: ________________________________________________________
Religious preference: ______________________________________________
Social Security Number: _____________________________
List any other names you have used: ________________________________________
How long have you lived in St. Lucie County: __________________________________
Have you ever been listed as a runaway juvenile? ______________________________
Have you ever been a member of a Jr. Cadet Program before? ___________________
If yes, where: _________________________________________________________
Name of family doctor: ___________________Phone number: (______)__________
Do you have any allergies, physical defects, or emotional conditions which would
prevent:
______ running
______ swimming ______ self defense training
_____Climbing ______ firearms training ______ or any other supervised activities?
If yes, please explain:
______________________________________________________________________
______________________________________________________________________
If there is any other information you think is pertinent to this application, please explain
here: ________________________________________________________________
_____________________________________________________________________
Jr. Cadet Application
Pg. 2
St. Lucie County Sheriff’s Explorer Post 400
Junior Cadet
PERSONAL HEALTH AND MEDICAL SUMMARY
To be completed by parent or guardian (please print)
Name: _________________________________ Date of Birth: ____________ Age: ____ Sex: M __ F__
Name of parent/guardian _______________________________ Telephone: (______)_______________
Home address: ________________________________ City ____________State ______ Zip _________
Business Address ____________________________City ______________State ______ Zip _________
Telephone (_____) ___________________ Cell phone (______) _________________________
If person above is not available in the event of an emergency, notify:
Name _______________________ Relationship ______________Telephone (_______)_____________
Name ______________________ Relationship ______________ Telephone (_______)______________
Name of personal physician ___________________________ Telephone (_______)________________
Personal Health/Accident Insurance Carrier _______________________Policy Number _____________
In case of emergency, I understand every effort will be made to contact me. In the event I cannot be
reached, I hereby give permission to the physician selected by the adult leader in charge to secure proper
treatment, including hospitalization, anesthesia, surgery, injections, or medication for my child.
_____________________________
_____________________________________________
Date
Parent/Guardian Signature
Medical information past or present (please check)
Asthma
_____ Yes
_____ No
Cancer
_____ Yes
_____ No
Convulsions
_____ Yes
_____No
Hemophilia
_____ Yes
_____ No
Diabetes
_____ Yes
_____ No
High Blood Pressure
_____ Yes
_____ No
Heart disease
_____ Yes
_____ No
Leukemia
_____ Yes
_____ No
Explanations:
___________________________________________________________________________________
List any conditions limiting full participation (Physical or emotional)
____________________________________________________________________________________
____________________________________________________________________________________
List medicines: _____________________________________________
Explain any YES answers and give all information needed to provide as safe and as full participation as
possible: ___________________________________________________________________________
List date of last inoculations for:
Diphtheria
__________
Measles
Mumps
__________
Rubella
__________
__________
Polio
__________
Pertussis __________
Tetanus Toxiod __________
We will request this form to be completed on several occasions; you may wish to keep the basic information readily
available.
Jr. Cadet Application
Pg. 3
St. Lucie County Sheriff’s Explorer Post 400
Junior Cadet
CO2 TRAINING PERMISSION/RELEASE OF LIABILITY
Part of the training and activities the Jr. Cadets participate in is marksmanship training and
competition. This activity is optional, not mandatory. Marksmanship training is only conducted
and supervised by instructors in strict accordance with the guidance’s established by the Boy
Scouts of America and St. Lucie County Sheriff’s Office. If you wish your child to participate in
this program, the RELEASE OF LIABILITY/ PERMISSION form must be signed and notarized.
No Explorer will be permitted to participate until this form is returned.
I, ___________________________________________, the undersigned parent/legal
guardian of Explorer ___________________________________, give permission for
my son/daughter to participate in firearms training/competition with Explorer Post 400.
I understand that this privilege may be terminated by the Explorer Post or agent of St.
Lucie County Sheriff’s Office if the Explorer fails to follow any instructions during training
or competition.
______________________________________
_________________________
Print name ( Parent/Guardian)
Parent/Guardian Signature
________________________________________________________
_______________________________
Print Explorer Name
Date
State of Florida
County of St. Lucie
Sworn to and subscribed before me this ____________ day of ______________________________________ 20 _____________
________________________________________________________ My Commission Expires:
Notary Public
Jr. Cadet Application
Pg. 4
Consent to Release to
Newspapers, TV
To publicize the achievement of our Explorers, Junior Cadets and Cadets, and the great
work they do for our community, we occasionally publish our explorer’s names,
photographs, achievements and awards to local newspapers or TV. We may also post
the information on the Sheriff’s Explorer Web site.
By signing this form I consent to having my child’s photo, name, awards and
achievements published in the newspapers/or newsletters, TV or Sheriff’s Explorer
Web site.
Dated this ____day of _______________20 ___.
Witness:
____________________________
_______________________________
Signed: Explorer
____________________________
_______________________________
Signed: Parent/Legal Guardian
State of Florida
County of St. Luice
Sworn to and subscribed before me this _____day of ______________20___
_______________________________ My commission Expires_____________
Notary Public
Jr. Cadet Application
Pg.5
JUNIOR CADET INTEREST SURVEY
Please check those activities, tours, projects, and seminars that you would like the Post to plan as part of its program.
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Airplane ride
Backpacking
Barbecue party
Bike hike
Block Party
Bowling
Camping
Canoeing
Christmas party
Civil defense
Council/district projects
Dance
Easter egg hunt for children
Family picnic
Family sports day
Fashion show
Fishing
Halloween Party
Have a Post reunion
Hobby smorgasbord
Horseback riding
How to buy a car
Ice-skating
Inter –post activities
Leisure-time sports
Mock trial
Operating a ham radio
Operating a recycling center
Organize a car wash
Orienteering
Pancake breakfast
Participate in a college panel
Plan a slide show
Put on a play
Rifle marksmanship meet
River rafting
Road rally
Rock climbing/repelling
Roller skating
Sailing
Ski weekend
Snorkeling/scuba diving
Spaghetti dinner
Sports tournament
Study the history of the town
Swim meet
Train trip
Winter camping trip
Work on a hiking trail
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Air Force base
Airport
Assist “Get Out The Vote” campaign
Assist handicapped citizens
Automobile plant
Career clinic
Child Care
Conduct a cleanup campaign
Conservation project
Council/district activities
Court sessions
CPR training
Dealing with people
Diet and nutrition
Drug abuse/alcoholism
Fire safety
First aid training
Gourmet cooking
Hair styling
Hospital volunteers
Hunting safety
Job-interview skills
Leadership skills
Local college or university
Local industry
Local offices of elected officials
Military career
Morality
Olympic sports
Organize a band
Parent’s night
Photography
Planetarium
Police Station
President’s Physical Fitness Test
Progressive dinner
Public speaking
Recognition dinner
Senior citizen organization
Sponsor “Summer Job Opportunity”
Sports medicine
Sports safety
Swimming/life savings
Trace the history of Post members
TV station
United Way campaigns
Weather Bureau
Write a newsletter
Other _____
Jr. Cadet Application
Pg. 6
For Official Use Only
Date of Meeting
______________________________
Date Application Received ______________________________
Investigation Assigned
______________________________
Investigation finding _________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Attached NCIC Records (if applicable) ____________________
Date Membership Voted
Accepted
Rejected
Date Applicant Notified
______________________________
______________________________
______________________________
______________________________
EXPLORING
Youth Application
The Exploring Learning for Life career education program is for young men and women who
are at least 14 (and have completed the eighth grade) and not yet 21 years old.
Exploring’s purpose is to provide experiences to help young people mature and become
responsible and caring adults. Explorers are ready to explore the meaning of interdependence
in their personal relationships.
Exploring is based on a unique and dynamic relationship between youth and the organizations
in their communities. Local community organizations initiate a specific Explorer post by matching
their people and program resources to the interests of young people in the community. The result
is a program of activities that helps youth pursue their special interests, grow, and develop.
Explorer posts can specialize in a variety of career skills. Exploring programs are based upon
five areas of emphasis: career opportunities, life skills, citizenship, character education, and
leadership experience.
524-309
2012 Printing
Youth/adult
participant fee
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
1.25
2.50
3.75
5.00
6.25
7.50
8.75
10.00
11.25
12.50
13.75
15.00
16.25
17.50
18.75
20.00
21.25
22.50
Mailing address example:
0
3
F
I
R
S
T
S
T
Youth
• Print—do not use cursive.
Participant
1 2 3 4
A N Y
5 5 5 - 1 2 3 - 4 5 6 7
H
I
S C H O O L
G H
@
 Parent

•
s u e
1 2 3 4
_______________________________________________________
Date
a n y
s t r e e t
Home phone Grandparent
1 2 3
-
• Fill in radio buttons completely.
State
Zip code
Ethnic background:
n y
•
 Black/African American  Native American
 Caucasian/White
 Hispanic/Latino
 Male
 Female
Gender:
1 2 3 4 5
 Alaska Native
 Pacific Islander
 Other (specify)
s m i
Ext.
-
X
Parent/guardian email address
Suffix
City
State
a n y t o w n
n y
Zip code
1 2 3 4 5
Employer Previous Scouting experience
Cellphone
-
-
• Make sure you have all needed
@
signatures
on application.
Bill Taylor
Signature of post leader
Participation fee $
.
I have read the attached information sheet and approve the application
(signature of parent/guardian required if applicant is under 18 years of age).
/
Deborah Sue Smith
/
Date
Paid:
Cash
Signature of parent/guardian
Check No. _______
Credit card
 Asian
 Other
t h
0 1 / 0 1 / 1 9 7 2
4 5 6 7
Business phone
-
Suffix
T H
Last name
Date of birth (mm/dd/yyyy)Occupation -
E
L
Post
number:
t o w n
1 0
Middle name
Mailing address
5 5 5
A
S
 Guardian
d e b o r a h
U S
_______________________________________________________
Post leader signature
City
0 1 / 0 1 / 1 9 9 5
Email address
Country
is a member of ____________________________________________
S M I
Grade
School
Parent/guardian information  
Select relationship:
First name (No initials or nicknames)
_______________________________________________________
Last name
A N Y
Date of birth (mm/dd/yyyy)
t r e e
This certifies that
P
M
S T R E E T
Phone
o a k
(Good for 60 days)
Use black or blue ink only.
• Print one letter or number
only
in each
box. (Please print one letter in each space—press hard, you are making a copy.)
Name and
address
information
• Use upper-case First name
(No initials
or nicknames)
Middle name
letters
and stay
within the
blue boxes for legibility.
K A T H L E E N
J A N E
Country
Mailing address
U S
TEMPORARY Participant CERTIFICATE
Signature of Explorer
Gender:
 M
 F
•
524-309
Term per
month
Retain on file for three years.
Print—do not use cursive.
Use black or dark blue ink.
Press firmly when printing.
Print one letter only in each box.
Use upper-case letters and stay within the blue boxes for legibility.
Fill in circles; do not use check marks.
Make sure you have all needed signatures on application.
Don’t alter the application—it could affect the quality of the scan.
7
Cut along dotted line.
Participant Chart
Tips for completing the Application for Exploring Youth Participant:
Youth
Participant
Post
number:
If applicant has an unexpired participant certificate, participation may be accomplished in this unit by paying $1 for processing the transfer. Mark and attach certificate. It will be returned by the council.
Post
number:
Transfer from council No.:
 Transfer application
Name and address information (Please print one letter in each space—press hard, you are making a copy.)
First name (No initials or nicknames)
Middle name
Country
Mailing address
Last name
Suffix
City
State
Zip code
US
Date of birth (mm/dd/yyyy)
-
-
/
Grade
Ethnic background:
 Black/African American  Native American
 Caucasian/White
 Hispanic/Latino
/
School

Gender:Male
 Female
 Alaska Native
 Pacific Islander
 Asian
 Other
LOCAL COUNCIL COPY
Phone
Email address
@
Parent/guardian information  
Select relationship:
First name (No initials or nicknames)
Country
 Parent
 Guardian
(specify)
 GrandparentOther

Middle name
Last name
Mailing address
Suffix
City
State
Zip code
Date of birth (mm/dd/yyyy)Occupation -
-
/
Business phone
-
Gender:
 M
/
Ext.
-
Employer Previous Exploring experience
 F
Cellphone
X
-
-
Parent/guardian email address
@
I have read the attached information sheet and approve the application
(signature of parent/guardian required if applicant is under 18 years of age).
/
Date
Signature of post leader
Participation fee
/
$
.
Paid:
Cash
Check No. _______
Signature of parent/guardian
Credit card
Signature of Explorer
Retain on file for three years.
Home phone 524-309
US
Youth
Participant
Post
number:
If applicant has an unexpired participant certificate, participation may be accomplished in this unit by paying $1 for processing the transfer. Mark and attach certificate. It will be returned by the council.
Post
number:
Transfer from council No.:
 Transfer application
Name and address information (Please print one letter in each space—press hard, you are making a copy.)
First name (No initials or nicknames)
Middle name
Country
Mailing address
Last name
Suffix
City
State
Zip code
US
Phone
Date of birth (mm/dd/yyyy)
-
-
/
Grade
Ethnic background:
 Black/African American  Native American
 Caucasian/White
 Hispanic/Latino
/
School

Gender:Male
 Female
 Alaska Native
 Pacific Islander
 Asian
 Other
POST COPY
Email address
@
Parent/guardian information  
Select relationship:
First name (No initials or nicknames)
Country
 Parent
 Guardian
(specify)
 GrandparentOther

Middle name
Last name
Mailing address
Suffix
City
State
Zip code
Date of birth (mm/dd/yyyy)Occupation -
-
/
Business phone
-
Gender:
 M
/
Ext.
-
Employer Previous Exploring experience
 F
Cellphone
X
-
-
Parent/guardian email address
@
I have read the attached information sheet and approve the application
(signature of parent/guardian required if applicant is under 18 years of age).
/
Date
Signature of post leader
Participation fee
/
$
.
Paid:
Cash
Check No. _______
Signature of parent/guardian
Credit card
Signature of Explorer
Retain on file for three years.
Home phone 524-309
US
Youth
Participant
Post
number:
If applicant has an unexpired participant certificate, participation may be accomplished in this unit by paying $1 for processing the transfer. Mark and attach certificate. It will be returned by the council.
Post
number:
Transfer from council No.:
 Transfer application
Name and address information (Please print one letter in each space—press hard, you are making a copy.)
First name (No initials or nicknames)
Middle name
Country
Mailing address
Last name
Suffix
City
State
Zip code
US
Date of birth (mm/dd/yyyy)
-
-
/
Grade
Ethnic background:
 Black/African American  Native American
 Caucasian/White
 Hispanic/Latino
/
School

Gender:Male
 Female
 Alaska Native
 Pacific Islander
 Asian
 Other
Email address
@
Parent/guardian information  
Select relationship:
First name (No initials or nicknames)
Country
 Parent
 Guardian
(specify)
 GrandparentOther

Middle name
Last name
Mailing address
Suffix
City
State
explorer COPY/receipt
Phone
Zip code
Date of birth (mm/dd/yyyy)Occupation -
-
/
Business phone
-
Gender:
 M
/
Ext.
-
Employer Previous Exploring experience
 F
Cellphone
X
-
-
Parent/guardian email address
@
I have read the attached information sheet and approve the application
(signature of parent/guardian required if applicant is under 18 years of age).
/
Date
Signature of post leader
Participation fee
/
$
.
Paid:
Cash
Check No. _______
Signature of parent/guardian
Credit card
Signature of Explorer
Retain on file for three years.
Home phone 524-309
US