WASHINGTON WING

CADET ACTIVITY APPLICATION

**(If form is not legible you may not be selected for the activity that
you want to attend)**

**NAME:** Last Name, First Name, Middle Initial **Date Joined CAP**

[Month: Year:]{.underline}

**MAILING ADDRESS**: (Number and Street)

**CITY** **STATE** **ZIP CODE HOME PHONE**

[( ) \_\_\_\_\_-\_\_\_\_\_]{.underline}

######### UNIT NAME: CHARTER NUMBER

######### CAPID CAP GRADE DATE OF BIRTH AGE

[\_**MM**\_\_\_ \_ **DD**\_\_ **YY** \_\_\_\_\_\_\_\_]{.underline}

# E-MAIL ADDRESS GENDER HEIGHT WEIGHT HAIR EYES

**[M -- F (CIRCLE )]{.underline}**

**SCHOLASTIC ACHIEVEMENT RELIGIOUS PREFERENCE**

Grade Level Completed: \_\_\_\_ College Years: \_\_\_\_

####### DESIRED ACTIVITY (check only one box per application)

######## [ENCAMPMENTS]{.underline} [FLIGHT CAMPS]{.underline} [TRAINING]{.underline} [OTHER]{.underline}

########  \_\_ Summer \_\_ Power \_\_ WTA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_ Winter \_\_ Glider \_\_ ESTA

**[STAFF APPLICATIONS (only)]{.underline}**

Desired Position 1. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 2.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

# PREVIOUS EXPERIENCE: (staff applications only)

Activity Dates Attended Position Held

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**RELEASE AGREEMENT**

KNOW ALL MEN BY THESE PRESENTS that I am submitting my application for
Civil Air Patrol, Washington Wing activities, and I hereby volunteer
entirely upon my own initiative, 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\. Travailing in US Military, Civil Air Patrol, commercial, or private
owned vehicle from regular place of the activity, travel

incident to the activity, and subsequent return to place of the
activity.

2\. Participation in aeronautical activities as a passenger or a student
trainee in US Military, Civil Air Patrol, 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.

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 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.

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DATE SIGNATURE OF CADET

WWForm 23 Jan 98 **CONTINUE ON THE BACK**

#### PREVIOUS EDITIONS OBSOLETE

## RELEASE BY PARENTS OR GUARDIAN

KNOW ALL MEN BY THESE PRESENTS: WHEREBY my child has applied for the
activity referred to above. 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 officers, agents and employees acting official or otherwise, from
any and all claims, demands, actions, or causes of action, on account of
the death or an account of any injury to my child 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.
In addition, by my signature below, I certify the applicant:

1\. Is my minor child or ward.

2\. Has no history of injury or disease which might be affected by this
activity except those previously noted in the Washington Wing Medical
Information form.

3\. Will follow all rules, regulations, and directives as established by
the Civil Air Patrol, Inc., activity

commander or activity project officer, or other staff members. If not
following the above-mentioned rules, regulations, and directives he/she
may be sent home at the discretion of the activity commander or activity
project office at my expense.

However, in case of injury, disease or other illness, permission is
hereby granted to treat the applicant as required, and if the applicant
is released from the activity before recovery from said injury, disease,
or illness, further treatment will be provided by myself.

**[Refund Policy]{.underline}**

1.  All applications for any activity must be complete and be
    accompanied by **full payment** or the application will not be
    processed.

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2.  All **out-of-state** cadets must send only a cashier's check or
    money order. No Personal checks.

3.  **Refund Policy:** All requests for refunds must be in writing and
    postmarked by the dates shown below.\
    a. Cancellations **14 or more days** before the scheduled activity
    will receive a 90% refund.\
    b. Cancellations **5 -- 13 days** before the scheduled activity will
    receive a 50% refund.\
    c. Cancellation **4 days** or less before the scheduled activity
    will receive 0% refund.

**(PARENT/GUARDIAN INITIAL HERE) I/We have read & understand the refund
policy.**

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**DATE [Print Name]{.underline} of [Witness]{.underline} for Father's
Signature [Print Name]{.underline} of Father/Legal Guardian**

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**[WITNESS]{.underline} SIGNATURE [FATHER/LEGAL GUARDIAN
SIGNATURE]{.underline}**

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**[Print Name]{.underline} of [Witness]{.underline} for Mother's
Signature [Print Name]{.underline} of Mother/Legal Guardian**

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#####  WITNESS SIGNATURE MOTHER OR LEGAL GUARDIAN SIGNATURE

I certify that the applicant is qualified to attend a CAP activity and
recommend approval of the application. Flying (is) (is not) authorized
by cadet's parents or guardian.

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**DATE [Print Name]{.underline} of Sqdn. Commander/Deputy CC for Cadets
Signature of Sqdn. CC/Deputy CC for Cdts.**

WWForm 23 June 2001 **PREVIOUS EDITIONS ARE OBSOLETE**