APPLICATION FOR CADET ACTIVITES
TITLE OF ACTIVITY

LOCATION OF ACTIVITY

ACTIVITY START and END DATE

NAME (Last Name, First Name, Middle Initial)

JOINED CAP: MM YY

GENDER

CAP GRADE

AGE

CAPID

MAILING ADDRESS (Number and Street)

SOCIAL SECURITY NUMBER:

___ - __ - ____

(City)

(State)

(Zip Code)

(Home Phone):

WING

UNIT CHARTER NUMBER

SQUADRON NAME

(Business Phone):

SCHOLASTIC ACHIEVEMENT

High School Graduate

GROUP NAME

REGION

(Cell Phone):

College	Years

Post Graduate	Years	E-MAIL ADDRESS

RELIGIOUS PREFERENCE

T-SHIRT SIZE (Not relevant for all activities)
Check if you would like to be considered for a staff position for this activity.

(Not relevant for all activities)	Position?
MEDICAL INFORMATION:	(List physical handicaps or ailments for which applicant will be taking medication during this activity or which might affect applicant’s ability to engage in all aspects of activity. Provide a list of medications taken regularly. Use additional sheet, if required.)

EMERGENCY ADDRESSE (Parent, Guardian, or Closest Relative to be notified in case of emergency.)
NAME	RELATIONSHIP
ADDRESS	AREA CODE	PHONE NUMBER
HOME
BUSINESS

I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

Signature of Applicant Date
CAP Membership Card or Proof of Membership Required to Attend Activity.

DO NOT FORGET TO SIGN OTHER SIDE.
NYWF 17C (15FEB 03) Page 1 of 2 (Previous editions are obsolete)	Local Reproduction Authorized (Copy BOTH Sides)

CIVIL AIR PATROL RELEASE AGREEMENT (ALL MUST SIGN)

KNOW ALL MEN BY THESE PRESENTS that I am submitting my application for Civil Air Patrol Special 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. 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 Civil Air Patrol, rendering reports on the activity.

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

DATE	SIGNATURE OF APPLICANT
RELEASE BY PARENTS OR GUARDIAN (ONLY IF UNDER 18)

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 or activities, 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 or activities 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 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 or activity director 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.

DATE	WITNESS FOR FATHER’S SIGNATURE	FATHER OR LEGAL GUARDIAN

WITNESS FOR MOTHER’S SIGNATURE	MOTHER OR LEGAL GUARDIAN

SQUADRON CERTIFICATION

(Required for ALL activites)

I certify that the applicant is a cadet in good standing in my unit and I approve his/her request.

SQUADRON COMMANDER
NYWF 17C (15FEB 03) Page 2 of 2

Application for Cadet Activities

NYW FORMS

Any comments concerning this form should be directed to NY Wing Cadet Programs.

Col Austyn W. Granville Jr., CAP

2004-02-03

PRIMARY

Civil Air Patrol, New York Wing