SOUTHEAST REGION CADET ACTIVITY APPLICATION

### 

+-----------------------------------------------------------------------+
| ### RELEASE AGREEMENT                                                 |
|                                                                       |
| ### KNOWN ALL MEN BY THESE PRESENTS that I am submitt                 |
| ing my application for this Civil Air Patrol activity, and I hereby v |
| olunteer entirely upon my own imitative, risk, and responsibility for |
|  an assignment to participate in this activity at the first available |
|  opportunity and with full knowledge that such activity MAY include:  |
|                                                                       |
| 1.  Traveling by land, sea, or air in US MILITARY, commercial, or     |
|     privately owned vehicles from regular place or residence to the   |
|     site of the activity, travel incident to the activity, and        |
|     subsequent return to place of residence.                          |
|                                                                       |
| 2.  Participation in aeronautical activities as a passenger or        |
|     student trainee in US MILITARY, commercial, or privately owned    |
|     aircraft.                                                         |
|                                                                       |
| 3.  Living for a period of one week or more on diminished rations and |
|     minimal shelter simulating actual survival conditions.            |
|                                                                       |
| 4.  Being quartered and/or subsisting away from regular or normal     |
|     place of residence for an extended period of time.                |
|                                                                       |
| 5.  Remaining with the cadet group I am assigned to at all times      |
|     during the activity.                                              |
|                                                                       |
| 6.  Acting as a spokesman for the Civil Air Patrol, rendering reports |
|     on the activity.                                                  |
|                                                                       |
| 7.  Refraining from argumentative discussions concerning governmental |
|     policies.                                                         |
|                                                                       |
| 8.  Physically demanding exercise and/or tasks.                       |
|                                                                       |
| 9.  Being ordered home or suspended from activity functions as a      |
|     result of a disciplinary action as determined by the officer in   |
|     charge.                                                           |
|                                                                       |
| In consideration of the permission extended to me by the Civil Air    |
| Patrol/United States of America through its officers and agents to    |
| participate in said activity, I do hereby for myself, my heirs,       |
| executors, and administrators release and forever discharge the Civil |
| Air Patrol, Inc/United States of America, and all its officers,       |
| agents, and employees acting official or otherwise, from any and all  |
| claims, demands, actions, or causes of action, on account of my death |
| or on account of any injury to me or my property which may occur as a |
| result of the negligence of the Civil Air Patrol/United States of     |
| America, its agents or employees during said activity or continuances |
| thereof, as well as all ground and flight operations incident         |
| thereto.                                                              |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                     |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_          |
|                                                                       |
| SIGNATURE OF APPLICANT DATE                                           |
+-----------------------------------------------------------------------+
| ### RELEASE BY PARENTS OR GUARDIAN                                    |
|                                                                       |
| ### KNOWN ALL MEN BY THESE PRESENTS: WHEREBY my c                     |
| hild has applied for the activity referred to on the first page of th |
| is document, in consideration of the permission extended to my child  |
| by the Civil Air Patrol/United States of America through its officers |
|  and agents to participate in said activity, I do hereby for myself,  |
| my heirs, executors, and administrators release and forever discharge |
|  the Civil Air Patrol, Inc/United States of America, and all its offi |
| cers, agents, and employees acting official or otherwise, from any an |
| d all claims, demands, actions, or causes of action, on account of my |
|  death or on account of any injury to me or my property which may occ |
| ur as a result of the negligence of the Civil Air Patrol/United State |
| s of America, its agents or employees during said activity or continu |
| ances thereof, as well as all ground and flight operations incident t |
| hereto.  In addition, by my signature below, I certify the applicant: |
|                                                                       |
| ###                                                                   |
|                                                                       |
| ### Is my minor child or ward.                                        |
|                                                                       |
| ### Has no history or injury or disease which might be affected       |
|  by this activity except those previously noted in the Medical Inform |
| ation section of the first page of this document and is able to parti |
| cipate without the physical/emotional support or others. Also, he/she |
|  is capable of taking any prescribed medication without supervision.  |
|                                                                       |
| ### Will follow all rules, regulations, and di                        |
| rectives as established by the Civil Air Patrol activity project offi |
| cer or officer in charge or encampment commander. If he/she does not  |
| follow the activity rules, regulations. and directives written or ver |
| bal, he/she may be sent home at the discretion of the activity projec |
| t officer or officer in charge or encampment commander at my expense. |
|                                                                       |
| ### Participation in aeronautical activities as a passenger or stu    |
| dent trainee in US MILITARY, commercial, or privately owned aircraft. |
|                                                                       |
| ### I have read, understood, and agree to                             |
|  all items as outline in the Release Agreement section and Release by |
|  Parents or Guardian section. I also certify that ALL information on  |
| as part of this document is true to my knowledge.  However, in case o |
| f injury, disease or other illness, permission is hereby granted to t |
| reat the applicant/participant as required, and if the applicant/part |
| icipant is released from the activity before recovery from said injur |
| y, disease, or illness, further treatment will be provided by myself. |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                     |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_          |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                   |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| SIGNATURE OF FATHER OR LEGAL GUARDIAN DATE WITNESS FOR FATHER'S       |
| SIGNATURE                                                             |
|                                                                       |
| (Must be signed by an adult other than parent/legal guardian)         |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                     |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_          |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                   |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| SIGNATURE OF MOTHER OR LEGAL GUARDIAN DATE WITNESS FOR MOTHER'S       |
| SIGNATURE                                                             |
|                                                                       |
| (Must be signed by an adult other than parent/legal guardian)         |
+-----------------------------------------------------------------------+
| ### UNIT CERTIFICATION                                                |
|                                                                       |
| To my knowledge:                                                      |
|                                                                       |
| 1.  I certify that ALL of the information on this form is complete    |
|     and correct.                                                      |
|                                                                       |
| 2.  This applicant meets the activity prerequisites and is prepared   |
|     to attend this activity.                                          |
|                                                                       |
| 3.  This applicant has no history of injury or disease which might be |
|     affected by this activity except those previously noted in the    |
|     Medical Information section of this form.                         |
|                                                                       |
| 4.  This applicant will follow all rules, regulations, and directives |
|     as established by the Civil Air Patrol, the activity project      |
|     officer or officer in charge or encampment commander or other     |
|     staff members. If he/she does not follow the activity rules,      |
|     regulations, and directives, he/she may be sent home at the       |
|     discretion of the activity project officer or officer in charge   |
|     or encampment commander at *[parental or **unit**]{.underline}*   |
|     expense.                                                          |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                              |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_          |
|                                                                       |
| SIGNATURE OF UNIT COMMANDER OR DEPUTY COMMANDER FOR CADETS DATE\      |
| \                                                                     |
| \                                                                     |
| \_\_\_\_\_\_\_\_\_\_                                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| PRINT NAME                                                            |
+-----------------------------------------------------------------------+

###