**CADET APPLICANTS UNDER 18**

PLEASE READ & RETURN THIS CHECK LIST WITH THE ATTACHED ITEMS

**to [arrive]{.underline} at Encampment Admin [as soon as
possible.]{.underline}** **Originals must be received by 10 May 2008.
Mail to:**

**Colorado Wing, CAP Encampment**

**19210 E. Breckenridge Ave. Stop 33**

**Buckley AFB, CO 80011-9587**

**[CANCELLATION POLICY:]{.underline}** Less than 30 days (15 May 08) NO
refund

Extenuating circumstances will be reviewed by the Encampment Finance
Committee.

**Please return all of the listed items completely filled out, and
signed and/or notarized as needed:**

\_\_\_\_ CAP Form 31

\_\_\_\_\_ Encampment Deposit (\$50), payable to Colorado Wing, CAP
Cadet Programs.

Enter the check number \_\_\_\_\_\_\_\_\_\_ and amount:
\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_ Media Release Form (Optional, but you will be omitted from
all newsletters/web pages)

\_\_\_\_\_ Hold Harmless Agreement

\_\_\_\_\_ Special Power of Attorney Indemnification

\_\_\_\_\_ CAPF 60 Emergency Notification & Medical Data Form (All
blocks must have **[complete and legible]{.underline}** entries)

\_\_\_\_\_ Any supplemental medical information you wish the encampment
to have on file.

\_\_\_\_\_ **Legible copy of both sides of your [medical insurance
card]{.underline}, or a statement that you have no insurance.**

\_\_\_\_\_ Additional Information sheet:

Special Food Needs

Religious service option

Travel plans, regardless whether you live inside or outside of Colorado
-- mandatory

T-shirt size

> Names of all guests who will be attending the graduation parade
> (required for security entry).

\_\_\_\_\_ This sheet, signed and dated below.

I (print name)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ have read
and understand all of the information sent to me or downloaded by me. If
there was something I did not understand, I discussed it with Lt.
Colonel Steve Budd-Jack, the encampment commander (email:
ranger@coloradofiretraining.com, home phone (970) 533-7987). I am
attaching all required materials.

Member's signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2008 Colorado Wing Encampment

Media Release

TO: PARENTS, CADETS and SENIORS

We respect your family's privacy and the protection of you and/or your
child is important to us. The following information and signature are
required if you wish to allow information about you/your child and
you/your child's image to be used in the following ways:

Released to local newspapers/media and Civil Air Patrol News

Posted on Civil Air Patrol maintained websites

**Cadets under 18:**

I allow my child's name,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_;

hometown, \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_; and
image to be released to the general

public in the above mentioned ways.

Signature of Parent
/Guardian:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date:\_\_\_\_\_\_\_\_

**Cadets 18 and over and Seniors:**

I allow my
name,\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_;

hometown,\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_;
and image to be released to the

general public in the above mentioned ways.

Signature:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date:\_\_\_\_\_\_\_\_\_\_\_\_\_

My local newspaper is:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Phone/Fax:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Email:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

The cadet public affairs staff provides a daily newsletter during
encampment. Since this is printed and published, we require a signed
release. By signing above, you agree to allow name, image and
information about you/your child that is related to encampment to be
used in the newsletters, local newspapers, Civil Air Patrol News and on
CAP related websites.

CIVIL AIR PATROL, UNITED STATES AIR FORCE AUXILIARY

COLORADO WING CADET ENCAMPMENT

# AIR FORCE ACADEMY ,COLORADO

## MEMORANDUM FOR COWG/LO

FROM:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Parents Name

SUBJ: Medical Health Statement/Hold Harmless Agreement for Cadets Under
age 18 Years of Age

This is to certify that my son/daughter/ward, cadet
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, is in excellent
medical health and fully capable of participating in the Colorado Wing
Civil Air Patrol Cadet Encampment at the U.S. Air Force Academy on or
about 14-21 June 2008.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature Parent/Guardian of the Cadet Date

### HOLD HARMLESS AGREEMENT AND COVENANT NOT TO SUE

I,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,
do hereby certify that I am the parent or legal guardian of

cadet
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,
(hereinafter son/daughter/ward) who is voluntarily participating in the
Colorado Wing Civil Air Patrol Encampment.

Through this document (and others, if any) I give permission to CAP and
my son/daughter/ward for his/her participation. Participating in the
Cadet Encampment includes rigorous physical activities and involves the
risk of property damage and personal injury. I have considered these
risk and find it to be in the best interest of my son/daughter/ward that
he/she have the benefits of this educational experience in exchange for
assuming these risks and releasing others from any liability.

In consideration for my son/daughter/ward's participation in this
program, I agree for my son/daughter/ward, myself, my heirs and assigns,
forever, that none of us will ever institute, prosecute, or aid in any
way in the institution or prosecution of any demand, claim, or suit
against the United States (including the U.S. Government, Air Force, and
Air Force Academy), the Civil Air Patrol and/or any of their officers,
agents, volunteers, or employees, acting officially or otherwise, for
any personal injury or other damage to him/her which may occur from any
cause whatsoever as a result of his/her participation in this program. I
make this agreement on behalf of my son/daughter/ward, my heirs,
assigns, and myself. I agree personally, and on behalf of my
son/daughter/ward as his/her parent/guardian.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature Parent/Guardian of the Cadet Date

# SPECIAL POWER OF ATTORNEY INDEMNIFICATION

## 2008 COLORADO WING ENCAMPMENT

## CIVIL AIR PATROL

1\. I, (Name of Parent/Legal Guardian) hereby appoint the CAP Encampment
Commander, Lt. Col. Steve W. Budd-Jack, and those CAP Senior members in
charge, to act as my attorney-in-fact for the purposes stated below
during the Civil Air Patrol Encampment being held at the United States
Air Force Academy from 14 June through 21 June 2008. I request that my
attorney-in-fact:

1.  Reasonably provide for the health and welfare of my child,

> (Full Name) who is years of age.
>
> (Date of Birth: Month/Day/Year [.]{.underline}

2.  Make decisions and authorize any emergency treatment and/or medical
    or hospital care which may reasonably be required in the sole
    discretion of my attorney-in-fact: and

3.  Promptly inform me of any significant injury or concern my
    attorney-in-fact may have about the health and welfare of my child.

2\. This special Power of Attorney shall be effective for the dates of
the encampment unless I earlier revoke it in writing. This Power of
Attorney shall not be affected by my disability or incapacity to act,
and shall continue in full force and effect during any period for which
I am disabled or incapacitated.

3\. I hereby indemnify and hold my attorney-in-fact and any other Civil
Air Patrol volunteers harmless from any and all claims, causes of
action, loss, liability, damage, attorney fees included in defense cost,
or costs they may incur as a result of acting as my attorney-in-fact
under this Power of Attorney. I understand that they are volunteers
working with this nonprofit program serving young persons in the State
of Colorado and that they neither represent themselves as having any
special medical or psychological expertise nor are they in any way
compensated for their volunteer service.

I,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
, Parent/Guardian of the above named cadet, sign

> (Print Name)

this document on\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_2008.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Signature--MUST be witnessed by a notary)

Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

County of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
State of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Home phone) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (Work
phone)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

This document was acknowledged before me on \_\_\_\_\_\_\_\_\_\_\_\_\_
day
of\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_2008

by
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Witness my signature, official designation, and seal.

My commission expires \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> Notary
>
> Seal

<table>
<colgroup>
<col style="width: 20%" />
<col style="width: 28%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 11%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 19%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="9"><strong>EMERGENCY NOTIFICATION DATA</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="9"><strong>PERSONAL INFORMATION</strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"><p>LAST NAME FIRST NAME MI</p>
<p>             </p></td>
<td colspan="4"><p>CAP RANK</p>
<p>     </p></td>
<td><p>CAPID</p>
<p>     </p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"><p>ADDRESS</p>
<p>     </p></td>
<td colspan="4"><p>CITY</p>
<p>     </p></td>
<td><p>STATE AND ZIP CODE</p>
<p>        </p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="9"><strong>CIVIL AIR PATROL UNIT INFORMATION</strong></td>
<td></td>
</tr>
<tr class="even">
<td><p>UNIT CHARTER NO.</p>
<p>     </p></td>
<td colspan="2"><p>UNIT NAME</p>
<p>     </p></td>
<td colspan="7"><p>UNIT LOCATION (City and State)</p>
<p>        </p></td>
</tr>
<tr class="odd">
<td colspan="3"><p>UNIT COMMANDER’S NAME</p>
<p>     </p></td>
<td colspan="3"><p>CAP RANK</p>
<p>     </p></td>
<td colspan="4"><p>TELEPHONE (Weekdays)</p>
<p>AC:       NO.      </p></td>
</tr>
<tr class="even">
<td colspan="5"><p>ADDRESS</p>
<p>     </p></td>
<td colspan="4"><p>TELEPHONE (Nights &amp; Weekends)</p>
<p>AC:       NO.      </p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="9"><strong>PERSON TO NOTIFY IN CASE OF
EMERGENCY</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"><p>NAME (Mr., Mrs., etc.)</p>
<p>     </p></td>
<td colspan="3"><p>RELATIONSHIP</p>
<p>     </p></td>
<td colspan="4"><p>TELEPHONE (Weekdays)</p>
<p>AC:       NO.      </p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><p>ADDRESS</p>
<p>     </p></td>
<td colspan="5"><p>TELEPHONE (Nights &amp; Weekends)</p>
<p>AC:       NO.      </p></td>
<td colspan="2"><p>CELL PHONE</p>
<p>     </p></td>
<td></td>
</tr>
</tbody>
</table>

**CAP FORM 60, DEC 03** Previous editions will not be used after 31 Mar
04 OPR/ROUTING: LMM

**EMERGENCY MEDICAL DATA**

PERSONAL PHYSICIAN [     ]{.underline} PHONE [     ]{.underline}

PHYSICIAN\'S ADDRESS [     ]{.underline} CITY [     ]{.underline}

BLOOD TYPE

PERTINENT MEDICAL DATA (Allergies, Diseases, Chronic Illnesses,
medications, etc.) [     ]{.underline}

[     ]{.underline}

[     ]{.underline}

**CAP FORM 60, DEC 03 REVERSE**

2008 COLORADO WING ENCAMPMENT

ADDITIONAL INFORMATION

# CAP MEMBER'S NAME \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**T-SHIRT SIZE (S, M, L, XL, XXL): \_\_\_\_\_\_\_\_\_\_**

**RELIGIOUS SERVICE OPTION:** During the encampment, it may be possible
to attend religious services, either at the Cadet Chapel, or at the
Community Center Chapel. If so, would you wish to attend these services?
\_\_\_\_\_\_\_\_ YES \_\_\_\_\_\_\_\_ NO

**SPECIAL FOOD NEEDS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**GRADUATION/PICK-UP GUESTS:**

NOTE: Security procedures at the Air Force Academy vary from time to
time. At times visitors are not allowed at the Prep School area. Anyone
wishing to come to the Graduation Pass-in-Review, or to pick up members
after the encampment, who is not a CAP or DOD member must be listed on
this form in case security is increased. List every one who will be in
the vehicle, not just the driver. No last minute changes will be
allowed.

## NAMES 

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Reminder: Per CAP Regulations, all cadets who drive themselves will be
required to relinquish their vehicle keys at check-in.