GPII ALS 2023 Participant Application w/CAPF60-81

Name*

Last NameFirst Middle Initial

CAPID*

Member Type*

CAP Grade*

Gender*

Charter No. *

(SWR-TX-123)

Group

Grade in School

Religious Preference

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number

Cell Phone Number

E-Mail Address*

example@example.com

Date of Birth *

MM/DD/YYY

Shirt Size*

Height

Inches

Weight

Lbs

Hair Color

Eye Color

Title of Activity

Location of Activity

Activity Dates Start

Date

Activity Dates End

Date

Primary Contact Name*

First NameMiddle InitialLast Name

Primary Contact Relationship*

Primary Contact Phone Number*

Secondary Contact Name*

First NameMiddle InitialLast Name

Secondary Contact Relationship*

Secondary Contact Phone Number*

KNOW ALL MEN BY THESE PRESENTS that I am submitting my application for Civil Air Patrol Special Activities or Encampments, and I hereby volunteer entirely upon my own initiative, risk, and responsibility for an assignment to participate in this activity of encampment 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 or encampment, travel incident to the activity or encampment, and subsequent return to place of residence.

2. Participation in aeronautical activities as a passenger or student trainee in US military, commercial, or privately ownedaircraft.

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 or encampment.

6. Acting as a spokesman for Civil Air Patrol, rendering reports on the activity or encampment.

7. Refraining from argumentative discussions concerning governmental policies.

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/encampment or activities/encampments, 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/encampment or activities/encampments or continuances thereof, as well as all ground and flight operations incident thereto.

I have read and agree to release agreement. (Cadet Signature)*

Clear

Date

MM-DD-YYYY

KNOW ALL MEN BY THESE PRESENTS: WHEREBY my child has applied for the activity or encampment referred to above, Inconsideration 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/encampment or activities/encampments, 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 on 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/encampment or activities/encampments 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 or injury or disease which might be affected by this activity except those previously noted in the Medical Information section of this form.

3. Will follow all rules, regulations, and directives as established by the Civil Air Patrol, Inc., activity project officer or encampment commander, 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 project officer, encampment commander or activity directory 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.

I have read and agree to the Release by Parents or Guardian. (Parent Signature)*

Clear

Father, Mother or Legal Guardian Name*

Squadron Certification.

YOU MUST PROVIDE A NAME AND VALID EMAIL FOR SQUADRON COMMANDER APPROVAL. YOU ARE RESPONSIBLE FOR FOLLOWING UP WITH YOUR SQUADRON COMMANDER TO ENSURE HE/SHE APPROVES THE APPLICATION PRIOR TO 1 October 2023. IF YOU DO NOT RECIEVE AN EMAIL STATING APPROVAL, YOU HAVE NOT BEEN APPROVED. CHECK AGAIN TO MAKE SURE YOUR EMAIL ADDRESS AND YOUR COMMANDER'S EMAIL ADDRESS IS VALID.

MOST Texas Wing EMAIL ADDRESSES ARE IN THE FORM FirstName.LastName@txwg.cap.gov

Squadron Commander Email*

example@example.com

Squadron Commander Name*

CAP GradeFirst NameLast Name

GP II ALS 2023 Participant Application

RELEASE AGREEMENT

RELEASE BY PARENTS OR GUARDIAN