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2. First Name:
3. Last Name:
4. Home Phone:
5. Cell Phone:
7. Address:
8. City:
9. State:
10. Zip:
12. Name of Explorer:
13. Explorer's Birthdate:
14. Relationship to Explorer:
18. Parents or Guardian must read and sign the following statement, before the Explorer application can be approved.
20. Driver Qualifications:

    When traveling to an Explorer event under the leadership of an adult (at least 21 years of age) tour leader, an Explorer at least 16 years of age may be a driver subject to the following qualifications:

    1). Six month driving experience as a licensed driver (time on a leaner's permit or equivalent is not to be counted).  2). No record of accidents or moving violations.  3). Parent permission has been granted to leader, driver, riders.

    Water Activities:

    In the event that the post trip activity takes place in total or in part on or near water, I certify that this Explorer has the following swimming level (select below).

22. Swimming Level:
    -- Select One --Non-swimmerBeginning swimmerIntermediate swimmerAdvanced swimmerLifeguard
24. Waiver of Claims

    “I am the parent, legal guardian, or participant (if over 18 years of age). I have read this document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) releasing the City of Rialto and participating organizations from all liability on my and the Participant’s behalf, (b) waiving my and the Participants’ right to sue any participating organizations, (c) and assuming all risks of Participant’s participation in all activities, including travel to and from the activities or any events incidental to activities. I allow the Participant to participate in all activities. I understand that I am responsible for the obligations and acts of the Applicant as described in this document. I agree to be bound by the terms of this document.”

    I approve and agree to all of the terms and conditions of this application and certify to its accuracy.  Further, I certify that this Applicant can meet the health and physical fitness requirements of the post trip, or activity.

    I have read this document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) releasing the City and participating organizations from all liability, (b) waiving my right to sue the City or participating organizations, (c) and assuming all risks of participating in all activities, including travel to and from activities or any events incidental to activities.

    
    

26. Signature: Parent/Guardian:

    __________________________________________________________________________________

27. Date:

    ______________________________________

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