LESA 2024 Application

LESA South Application CAPF60-81

26-31 December Brownsville, TX
Name*

Last NameFirst Middle Initial
CAPID*
CAP Grade*
Gender*
Member Type*
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 *

MonthDayYear
MM/DD/YYY
Current Age*
Shirt Size*
Height
Inches
Weight
Lbs
Hair Color
Eye Color
Date of Last Promotion*

MonthDayYear
This includes dead ranks.
Date Joined CAP*

MonthDayYear
MM-DD-YYYY
Title of Activity
Location of Activity
Activity Dates Start

MonthDayYear
Date
Activity Dates End

MonthDayYear
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*
RELEASE AGREEMENT
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)*
Date

MonthDayYear
MM-DD-YYYY
RELEASE BY PARENTS OR GUARDIAN
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)*
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 26 October 2024. 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
- NoCommandantDeputy CommandantExecutive OfficerSafetyLead InstructorInstructorAdminMessLogisticsPublic AffairsMedical
- Airman Leadership School (ALS)Non-Commissioned Officer School (NCOS)Cadet Training Education Programs (CTEP)Cadet Officer School (COS)EncampmentNational Cadet Special Activities (NCSA)Cadet Special Activities (CSA)National Flight Academy (NFA)Other
- NoCommandantDeputy CommandantExecutive OfficerSafetyLead InstructorInstructorAdminMessLogisticsPublic AffairsMedical
- NOCadet CommanderDeputy CommanderExecutive OfficerDirector of TrainingSafetyStandards & Evaluations LeadInstructor LeadCommand ChiefSquadron CommanderSquadron First SergeantFlight CommanderFlight SergeantStandards & EvaluationsInstructorAdmin OICLogistics OICPublic Affairs OICMedical OICMess OICCommunications OICGeneral Support Staff OICTransportation OICAdminLogisticsPublic AffairsMedicalMessCommunicationsGeneral Support StaffTransportation
- Please explain any other staffing experience.
- Position 2*
- Position 3*
- Essay Questions
  
  Please remember that an essay is not one paragraph.
- Commander Applicants Only: Who would you want on your executive staff and why?
  You are responsible for reaching out to these people and getting them to apply.
- All Applicants: What is your vision for LESA South?
- All Applicants: Please write a brief essay on your philosophy of responsibility while in command.*
- ALL Applicants: In what areas of leadership would you like further mentoring?
- All Applicants: What can you offer as staff to make LESA a successful event?*
- Should be Empty:

LESA South Application CAPF60-81

RELEASE AGREEMENT

RELEASE BY PARENTS OR GUARDIAN

Essay Questions