**CADET APPLICANTS OVER 18**

PLEASE READ & RETURN THIS CHECK LIST WITH THE ATTACHED ITEMS

**to [arrive]{.underline} at Encampment Admin Office [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 F31

\_\_\_\_\_ 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

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

**[legible]{.underline}** entries.)

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

\_\_\_\_\_ 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).

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

**insurance.**

\_\_\_\_\_ 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. Col.
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 news letter 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.

HOLD HARMLESS AGREEMENT AND COVENANT NOT TO SUE

(For Senior Members and Cadets over 18 Years of Age Only)

I,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
do hereby certify that I am voluntarily participating in the Colorado
Wing Academy Encampment at the U.S. Air Force Academy. I understand that
as *a participant* in this program I may participate in orientation
flights and other activities during the encampment. I understand and
agree that I am assuming the risk of personal injury that may result
while participating in this event. In consideration for my participating
in this program, I, for myself and my heirs, agree that I will never
institute, prosecute, or in any way aid in the institution or
prosecution of any demand, claim, or suit against the United States Air
Force, the United States Air Force Academy, the Civil Air Patrol, the
United States Government and/or any of their officers, agents, or
employees, acting officially or otherwise, in my own capacity, for any
injury to myself which may occur from any cause whatsoever as a result
of my participation in this program.

The term United States Government as used herein includes any officer,
agent, or employee of the United States Government acting officially or
otherwise.

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

Date Senior Member or Cadet over 18 years of age

<table style="width:100%;">
<colgroup>
<col style="width: 21%" />
<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: 1%" />
</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="3"><p>LAST NAME FIRST NAME MI</p>
<p>             </p></td>
<td colspan="5"><p>CAP RANK</p>
<p>     </p></td>
<td><p>CAPID</p>
<p>     </p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><p>ADDRESS</p>
<p>     </p></td>
<td colspan="5"><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="3"><p>UNIT NAME</p>
<p>     </p></td>
<td colspan="6"><p>UNIT LOCATION (City and State)</p>
<p>        </p></td>
</tr>
<tr class="odd">
<td colspan="4"><p>UNIT COMMANDER’S NAME</p>
<p>     </p></td>
<td colspan="2"><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.