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Basic Cadet Application Instructions 0

COWG Encampment Application Instructions

Basic Cadets - First Time Attendees

Before beginning this application, you must log in to CAP eServices, NOW, and confirm that all of your contact information is correct. Phone and Email communications prior to encampment may use the contact information in eServices. If your information in eServices is NOT correct, you may likely miss very important communications.

After completing this application packet,

DO NOT PRINT THE PACKET DOUBLE-SIDED! Use single-sided printing ONLY!

Double-sided printing causes significant problems when the packets are scanned to input data into the Encampment Database.

Encampment Admin will not process applications that are printed double-sided. Applicants will be notified by US POSTAL SERVICE Mail that the application must be re-submitted with single-sided printing. This is much easier to do correctly the first time rather than having to obtain all signatures again before re-submitting the application. Any delays resulting from having to re-submit the application packet may cost the applicant an encampment slot.

The published application deadline is a "received by" date - NOT a "postmarked by" date!

Application Instructions are continued on the next pages.

DO NOT MAIL THIS PAGE WHEN SUBMITTING APPLICATION

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Basic Cadet Application Instructions i

COWG Encampment Application InstructionsRead this document carefully before completing the attached application packet!

If you have NOT already completed the online encampment basic cadet Pre-Registration form, complete he online Basic Cadet Pre-Registration as indicated in the next sentence!

Click HERE to access and complete the online encampment basic cadet Pre-Registration form before continuing this application. (Be patient, the form loads slowly)

The Encampment Application packet is a fillable PDF form. The application packet must be completed on a computer. Most computers have Adobe Reader® installed for this type of task. You may have problems completing the form on your computer depending on the particular web browser you are using. Microsoft Edge DOES NOT support completion of fillable PDF files such as this one. The form has been tested successfully using Internet Explorer, Mozilla Firefox, and Google Chrome browsers.

You can save the packet to your computer by right clicking on the document and then selecting SAVE AS. When saving, use a convenient and easy to remember file name. You can then complete the application packet by opening the saved document using Adobe Reader®.

DO NOT PRINT THE BLANK APPLICATION PACKET AND COMPLETE IT BY HAND! Encampment will not accept applications that are not completed on a computer. The forms are often illegible and contain errors.

Applicants must complete the Curry Achievement before submitting this application!

Complete this Application Packet in its Entirety. Enter information in all data fields! • Complete the application on your computer. The packet can be completed using Adobe Reader®, which is

installed on most computers. Do not complete the application by hand. After completion, print the application and obtain all signatures before submission. Save an extra copy of the application packet after obtaining all signatures in case you need to submit another copy because of errors or omissions.

• Do not leave any data fields blank! If a particular data field is not applicable or requires no entry, enter “None”, “Not Applicable” or “N/A” in that field, as applicable. All fields must have something entered in them.

• Encampment Administrative Staff WILL NOT ACCEPT an application that is not complete. All data fields must be complete and all signatures completed.

• ENCAMPMENT WILL NOTIFY APPLICANTS BY U.S. POSTAL SERVICE MAIL OR POSSIBLY EMAIL IF APPLICATION CORRECTIONS ARE NEEDED. If notified of the need for corrections, submit corrections by return mail as soon as possible to increase chances of an encampment slot assignment. In some cases, this may require re-submission of the entire application packet. Be certain to save a copy with all signatures.

• Special Note for Cadet Applicants with May CAP Membership Expiration: If your CAP Membership expires at the end of May, make every effort to renew membership no later than 15 May. Failure to renew by that date may put a potential slot assignment at risk.

• Parent Signature(s) Missing: Unless applicants live in a single parent home, both parents must sign onsecond page of CAP Form 31, Application for CAP Encampment or Special Activity (Page 7 of packet). Ifapplicant is from a single parent home, only one parent signature is necessary. Parent signatures arerequired regardless of applicant’s age, even if the cadet is over 18.

Common Application Omissions/Problems

https://cowg.cap.gov/mission/cadet-programs/cadet-encampment/encampment/student-pre-registration/encampmentpre


Basic Cadet Application Instructions ii

• Adult Witness Signatures MIssing: An adult witness must witness parent(s) signatures on 2nd page of CAPForm 31, Application for CAP Encampment or Special Activity (Page 7 of packet). Witness must sign whereindicated. Minors (under 18) may not witness parent(s) signatures. Parents may witness for each other.

• Missing Squadron Commander Signature on CAP Form 31: Squadron commander must approve/sign on2nd page of CAP Form 31, Application for CAP Encampment or Special Activity (Page 7 of packet) Applicantmust complete Curry Achievement before Squadron Commander approves/signs application.

• Wrong Columns Checked on Items on CAP Form 160: Check either “Yes” or “No” for all 46 items on CAPForm 160, CAP Member Health History Form. (Page 9 of packet). Be certain to check the correct box for“Yes” or “No” on each condition. If an item is checked “Yes” and that item addresses more than onecondition, CIRCLE the specific item that justifies the “Yes” answer.

• No Explanation for “Yes” Answers on CAP form 160: Explain any “Yes” answer in the Remarks section onthe second page of CAP Form 160, CAP Member Health History Form, along with any other medicalcondition explanations. (Page 10 of packet)

• No Medical Insurance Information on CAP Form 161: Enter Medical insurance information, if any, in theappropriate section of CAP Form 161, Emergency Information. (Page 11 of packet) If no medical insurance,enter "None" or "N/A" in the medical insurance section. Do not leave this section blank.

• Missing Squadron Commander Phone Numbers on CAP Form 161: Commander’s phone numbers must beentered on CAP Form 161, Emergency Information. (Page 11)

Advance Disclosure of Pre-existing Medical Conditions

All applicants must disclose any/all pre-existing medical conditions, temporary or permanent, when submitting the application. This includes seemingly minor conditions such as in-grown toenails or other conditions that might deteriorate while at encampment. Encampment staff will evaluate pre-existing conditions to determine the need for special accommodations or the possibility that a cadet cannot fully participate in all encampment activities.

• Proper disclosure of pre-existing medical or physical conditions is an integrity issue!

• If a cadet arrives at encampment with an undisclosed pre-existing medical condition, dismissal fromencampment without refund of fees is possible.

• Document any pre-existing conditions known at the time of application in the Remarks section on thesecond page of CAP Form 160, CAP Member Health History Form. (Page 10 of packet)

• The Applicant General Information Document has a section titled Physical/Medical Restrictions orLimitations that discusses the physical examination requirement. If an applicant has any medical/physicalcondition that restricts or limits full participation in any encampment activities, this will requiresubmission of the CAP Form 162, CAP Member Physical Exam Form, (Page 11-A of the application packet)with a physician’s signature. (See Full Participation Description paragraph, below)

• After application submission, notify encampment staff of any new or changed pre-existing conditions bysending an E-Mail to the encampment E-mail address. Describe the new or changed pre-existing conditionby attaching a document to the E-Mail. A parent or guardian must sign this document if the cadet isunder age 18. Do not simply describe the condition in the E-Mail body. The encampment E-Mail address ison page v of these instructions.

• Encampment will expect applicants without physical/medical limitations or restrictions to participate, fully,in all encampment activities as described below.

Full Participation Description – Full participation in this encampment involves daily physical training exercises, USAFA ropes course team building activities, team sports, running, drill, standing in formation, possible climbing/rappelling, walking several miles daily, climbing multiple flights of stairs, climbing ladders, boarding Air Force Buses, boarding CAP vans, and exposure to sun and hot weather conditions.

Basic Cadet Application Instructions iii

Application Deadline – The application deadline date is This is a ”received by” date and NOT a “postmarked by” date! Any applications mailed after must include full payment of encampment fees of unless the applicant has been approved for CEAP assistance.

VERY IMPORTANT: After application submission, open any letters from encampment IMMEDIATELY! The letter will likely state that the application requires corrections or that the application does not require correction and has been accepted. Any needed corrections must be submitted immediately to ensure quick processing. A letter stating that the application has been accepted IS NOT AN ENCAMPMENTSLOT ASSIGNMENT CONFIRMATION! Cadets awarded encampment slot assignments will receive a specific slot assignment confirmation letter. These are usually mailed about mid-May. After application submission, do not make travel plans to encampment until after receiving the confirmation letter confirming a slot assignment.

Encampment Basic Cadet Fees are and may be paid by check or credit cards. Information about credit card payments is available at the end of these instructions. (page iv)

Payment options differ based on whether applicant is paying fees in full or is receiving financial assistance from the Colorado CAP Foundation or from the Cadet Encampment Assistance Program, CEAP, administered by CAP National Headquarters (NHQ).

Applicants NOT Applying for Financial Assistance: For applicants who have not applied for financial assistance through the Cadet Encampment Assistance Program (CEAP) or the Colorado CAP Foundation or do not plan to apply for financial assistance, there are two (2) payment options.

Option 1: Submit full payment for encampment fees of with the application packet, or

with the application packet and a final balance payment of

the deposit option (Option 2) is no longer available! Full payment must be included with all applications mailed after

Applicants Seeking Financial Assistance from CAP Foundation or CEAP: For those who plan to apply or have applied for financial assistance through the Colorado CAP Foundation or the Cadet Encampment Assistance Program (CEAP), your payment options are listed below:

CEAP Applicants: CEAP applications are submitted online to CAP National Headquarters (NHQ). CEAP approval is more likely for early CEAP applicants. Do not delay applying! Look for email instructions in early March. CAP NHQ administers the CEAP program and COWG Encampment is not involved in the CEAP online application or approval process. CEAP online applications and the encampment application packet are submitted separately. For CEAP applicants, no deposit or payment is required when submitting the encampment application. If the CEAP financial aid is approved, CAP National Headquarters notifies applicants and encampment staff. This notification should occur about a week after the squadron commander approves the CEAP application. Ask your squadron commander to approve your online CEAP application immediately after you submit it. CAP NHQ will not process CEAP applications until after squadron commander approval. Any delays in approval by squadron commanders may result in denial of CEAP assistance.

If you intend to apply for CEAP assistance, but have not already done so, complete the online CEAP application prior to submitting this encampment application packet.

NOTE: The encampment application packet has a place for each applicant to check off if he/she has applied for CEAP assistance. Encampment staff will confirm with CAP National Headquarters that applicants have applied for CEAP financial assistance.


Encampment Fees

Option 2: A deposit of no later than with the following exception. After


Basic Cadet Application Instructions iv

CAP Foundation Grant/Scholarship Applicants: The application window for the CAP Foundation Grants/Scholarships process has closed for this year. The encampment application packet has a place for applicants to check off if he/she has previously applied for a CAP Foundation Grant/Scholarship. Encampment staff will confirm with the CAP Foundation that applicants have actually applied for CAP Foundation financial assistance. CAP Foundation Grant/Scholarship applicants may pay encampment fees by submitting a deposit payment of

with the application and a balance payment according to the following instructions.

After awarding Grants/Scholarships, the CAP Foundation will notify the applicant’s home squadron if they will be receiving a CAP Foundation Grant/Scholarship award and the amount of the award. The CAP Foundation will pay the Grant/Scholarship award money directly to encampment for the recipient. The CAP Foundation Grant/Scholarship award amount is usually less than the balance owed for encampment fees and may vary for each individual applicant based on their need; therefore, award recipient/applicants are responsible for paying any final balance of encampment fees remaining after the deposit payment and the actual award amount paid by the CAP Foundation.

The final balance must be paid only by check, mailed to the encampment mailing address, shown on page v of the application packet instructions and must be received no later than

This is a “received by” date – not a “postmarked by” date!This balance cannot be paid by credit card. The Eventbrite Credit Card payment system cannot accept amounts defined by the user. Since the exact balance owed for each CAP Foundation awardee is not known, the system cannot be set up to accept payments for unknown amounts. Check payments are required. Cadets Requiring Gluten Free Meals: Encampment’s meal provider charges a $20.00 surcharge for cadets requiring gluten-free meals. This surcharge is not included in normal encampment fees and must be paid separately except for CEAP recipients. Those cadets desiring Gluten-Free meals who apply for CEAP but are not awarded CEAP, must pay the Gluten-Free surcharge in addition to all other encampment fees. The Gluten-Free meal surcharge may be paid only by check mailed to the encampment mailing address. Use mailing instructions on page v of these instructions. Credit card payments cannot be accepted for the Gluten-Free meal option. Credit Card Payments For Fees: Colorado Wing Encampment accepts credit cards for payment of encampment fees. Encampment uses Eventbrite to accept credit and debit cards with Eventbrite's secure payment processor.

Eventbrite charges a non-refundable fee for use of their service. If an applicant needs to cancel after making payment, request a refund by sending an email request before the NO REFUND DATE to the Encampment Email address in this document. The NO REFUND DATE is

There will be no refunds after that date since encampment has already committed funds for expenses.

Use the link, below, to access the Colorado Wing Encampment Basic/Student Cadet Payment Order Form of the Eventbrite Website.

https://www.eventbrite.com/e/credit-card-payments-cowg-cap-encampment-2020-student-cadets-first-time-encampment-attendee-tickets-94063383111

Check Payments for Fees: Those choosing to make any payments by check should make the check payable to Colorado Wing Encampment.

Include the applicant’s CAPID Number on the check’s memo line. Mail checks and application packets to the Encampment Mailing Address using the following instructions:

READ ALL INFORMATION ON THE FOLLOWING PAGE CAREFULLY!




Basic Cadet Application Instructions v

READ ALL INFORMATION ON THIS PAGE THORUGHLY!

>>>>>> MAIL application packets using US Postal Service First Class Mail – ONLY! <<<<<<<

The encampment mailing address is a Box at the Buckley Air Force Base Mail Facility. It is not a physical delivery address like your home mail. The Buckley AFB Mail Facility is not a traditional Post Office and does not accept any delivery requiring a receipt signature on behalf of Civil Air Patrol. Buckley AFB Mail Facility does not accept any overnight express delivery on behalf of Civil Air Patrol because it is unmanned during non-duty hours.

DO NOT USE FedEx, UPS, Priority Mail, Registered Mail, Certified Mail, or any method that might require a recipient signature. Using these methods will only DELAY arrival at the Encampment Admin Office.

PLEASE!!! DO NOT SEND ENCAMPMENT ANY OF THIS TYPE OF MAIL. Bad things often happen when you do. Encampment staff can share years of horror stories about Overnight, FedEx and Priority mail arriving months after encampment. Just do not do it! Encampment staff accepts no responsibility for processing this mail.

FAXED or EMAILED Applications WILL NOT BE ACCEPTED OR PROCESSED!

Fax and/or email is not secure and you risk compromising personally identifiable information. We do not provide a fax number! Even if you manage to find a FAX Number, the application will not be processed. In one recent year, a cadet actually faxed an application packet to a Fax number at the USAFA Preparatory School! Encampment did not receive it until mid-June after the start of encampment. That’s just a bit late and the Prep School Staff was very annoyed to have to deal with it!

The encampment email address IS NOT checked daily.

US Postal Service First Class Mail is the BEST, FASTEST, MOST RELIABLE, and LEAST EXPENSIVE method! Even if you have procrastinated and waited until the last possible minute, US POSTAL SERVICE FIRST CLASS MAIL is still the best option for all of the reasons listed above

DO NOT ATTEMPT TO STUFF THE APPLICATION PACKET INTO A LETTER SIZE ENVELOPE!

Mail the applications in a mailing envelope large enough so that paperwork does not require folding. Be certain to use adequate postage.

Using U.S. Postal First Class mail ONLY, send completed application packet to:

COWG Encampment 19210 East Breckenridge Avenue, Stop 33 Buckley Air Force Base, Colorado 80011-9525

Encampment Email Address: [email protected] This address is not checked daily.

mailto:[email protected]

Revised 12 August 2017

Colorado Wing Cadet Encampment

This document is a source of important information that may not be adequately addressed using the generic CAP Forms included in the application packet. It is very important that encampment staff have accurate and current contact information for all applicants, parents/guardians, and emergency contacts. E-Mail will be the primary method for routine communications to/from applicants and/or parents/guardians. Be certain that the contact E-mail addresses entered in this document will be valid through the end of encampment and will be checked regularly for new E-Mail. There are several forms that must be completed in this application packet. These forms will sometimes contain duplicate information. This packet is designed so that as you begin to enter information in the data fields, some of that information will automatically populate duplicate fields in the rest of the application packet documents. This reduces the time required to complete the application packet and reduces errors.

APPLICANT INFORMATION Position Applying For: Student Cadet Cadet Staff Senior Staff Applicant Last Name First Name (No Nicknames) Middle Initial CAPID Gender

Social Security Number Birth Month Birth Day Birth Year CAP Grade Grade in School (cadets)

Home Street Address or PO Box Number City State Zip Code

T-Shirt Size (Adult Size) Height (inches) Weight (Lbs) Hair Color Eye Color

Applicant E-Mail Address: Religious Preference If Other, Enter Specific Religion

Home Phone Number Cell Phone Number Unit Charter Number

If you selected “Other Unit Outside COWG” for Unit Charter Number, enter home wing (state) and unit charter number below. Home Wing (State) 2 Letter Abbreviation: Unit Charter Number: PARENT/GUARDIAN INFORMATION (Cadet Applicants Only) Parent/Guardian Name (Last, First, MI) Relationship to Applicant

Primary Phone Number Secondary Phone Number Parent/Guardian E-Mail Address

What is the BEST Contact Phone Number to be Used during the Dates/Time of Encampment? This number will be used first for any necessary contact. EMERGENCY CONTACT INFORMATION #1 (Primary Emergency Contact) This person may be a parent, guardian, relative, or family friend that you wish to be notified FIRST in case of an emergency. Primary Emergency Contact Name (Last, First, MI) Relationship to Applicant

Mailing Address City State Zip Code

Primary (Best) Phone Number Cell Phone Number Day Phone Number Night Phone Number

EMERGENCY CONTACT INFORMATION #2 (Secondary Emergency Contact)

This person may be a parent, guardian, relative, or family friend that you wish to be notified in case of an emergency if the Primary Emergency Contact, listed above, is not available or cannot be contacted. Secondary Emergency Contact Name (Last, First, MI) Relationship to Applicant

Mailing Address City State Zip Code

Primary (Best) Phone Number Cell Phone Number Day Phone Number Night Phone Number

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ENCAMPMENT FEE PAYMENT INFORMATION Did you apply for a Colorado CAP Foundation Grant to assist with encampment fees? Yes No

withEncampmentNo Staff will confirm with

Did you apply for Cadet Encampment Assistance Program (CEAP) financial assistance? Yes No If you answered “Yes”, encampment Staff will confirm that you applied for CEAP Financial Assistance. If you answered “Yes”, you are not required to make a payment with this application. If you are not awarded CEAP assistance, encampment staff will contact you and request full payment no later than

If you did not apply for financial assistance from one of the two sources above, you must use one of the following two fee payment options: 1. You may pay a deposit of with this application and the balance of

by 2. You may pay

OR in full with this application. No slot awards unless fees are paid in full.

Any applications mailed after must include full payment. The deposit option is not available after that date.

DRIVER’S LICENSE INFORMATION FOR CADETS 16 OR OLDER WITH DRIVER’S LICENSES

Entry requirements for some military installations require Driver’s License information for persons 16 or older. Cadets with Driver’s Licenses must enter the requested information below: Does the applicant have a Driver’s License? Yes No You Must Select “Yes” or “No” If you selected “Yes”, enter requested information below. If “No”, enter “None” or “NA” below. DL Number (include spaces or dashes): Issuing State: Expiration Date:

Page 2

Please confirm that the applicant's Birth Month, Birth Day, and Birth Year are correct below. Make corrections if necessary! Any corrections made here will automatically carry through and correct the rest of the forms.

Birth Month: Birth Day: Birth Year:

Continue the Application Packet by Completing the Documents on the Following Pages

No Encampment Slot Assignments will be made until encampment fees are paid-in-full!

If you answered "Yes", encampment staff will confirm that you applied for the Colorado CAP Foundation assistance.You may make a deposit payment of with this application and a payment of any balance owed after scholarship/grant payments by the Colorado CAP Foundation no later than

ARRIVAL AND DEPARTURE INFORMATION FOR ENCAMPMENT PARTICIPANTS

This document is used to collect information regarding the method of arrival and departure for each encampment cadet participant. Encampment senior staff must ensure that each minor cadet travels home in accordance with his or her parents’ or guardians’ instructions. Minor cadets will not be released from encampment to travel home except with the individuals designated by the parent(s) or guardian(s). CAP must ensure that minor cadets do not suddenly change their itineraries without parental permission. Any changes to the authorized persons list, below, must be communicated to encampment staff.

APPLICANT INFORMATION

Applicant Last Name First Name (No Nicknames) Middle Initial

Select Applicant Type

Basic Cadet Cadet Staff

What will be the applicant’s age on

PERSONAL VEHICLE INFORMATION

Will the applicant be driving a personal vehicle to encampment?

Yes No

If "Yes" was checked, enter vehicle make, model, and color and license plate number below:

Vehicle Make Vehicle Model Vehicle Color

License Plate Number State of Issue

Cadets who bring a personal vehicle to the encampment will park only in designated areas and hand‐over all vehicle keys, for storage, to the Encampment Transportation Officer immediately after arrival. Cadets will not operate or have access to personal vehicles during the encampment.

PERSONS AUTHORIZED TO PICK UP APPLICANT AT THE END OF ENCAMPMENT (Applicants under age 18 Only)

Name (Last, First, MI) Relationship Contact Cell Phone




PERSONS NOT AUTHORIZED TO PICK UP APPLICANT AT THE END OF ENCAMPMENT (Applicants under age 18 Only)

Please list the names of any person that is NOT authorized to pick up this minor cadet applicant during or at the end of encampment. Possible reasons may be for custody issues or other legal considerations. Enter NONE if applicable. Name (Last, First, MI) Relationship

Name (Last, First, MI) Relationship

SIGNATURE OF PARENT/GUARDIAN OF MINOR CADET APPLICANT

______________________________ Date (mmm-dd-yy)

________________________________________________________________ SignaturŜ of Parent or Guardian (Parent Signature Required for Minor Cadets)

REQUIRED FOR ALL CADETS DRIVING A PERSONAL VEHICLE TO ENCAMPMENT

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MEDICAL INSURANCE INFORMATION

Does the Applicant have Medical Insurance? Yes No

Additional information about Medical Insurance will be collected later in this packet.

PHYSICAL/MEDICAL RESTRICTIONS OR LIMITATIONS

NOTE: All pre‐existing medical conditions must be disclosed on CAP Form 160, CAP Member Health History Form. CAP Form 160 is included as part of this application packet. Cadets arriving at encampment with a pre‐existing medical condition not previously disclosed may be disqualified from encampment participation and will not receive any refund of encampment fees.

Does the applicant have a physical or medical condition, limitation, or restriction that will limit the applicant’s ability to fully participate in these activities at encampment?

Yes No

If "Yes" was selected, the apsigned by a physician. In this packet or the application wiThis form contains a placeclassification designations. limitations and their duratio

SPECIAL NOTE FOR APPLICAN

Except as indicated above, review of the applicant’s aapplicant’s safe participatioadditional information fromForm, in order to determine

Safely participate in Participate in only a Is wholly unsuited fo

If a physical examination isphysical exam results on acomplete this physical exammaintain/obtain an encampis essential to minimize dela

Where possible, accommod

Example: A cadet with a bromost other training at encam

If "Yes" was selected aboveabove, enter "None" in the

Participation in this encampment will involve daily physical training activities, team sports, running, drill, standing in formation, marching, walking several miles daily, climbing multiple flights of stairs, boarding Air Force buses and CAP vehicles, exposure to sun and summer weather conditions.

plicant must submit a CAP Form 162, CAP Member Physical Exam Form, completed and case, the completed and signed CAP Form 162 must be submitted with the application ll not be accepted. The CAP Form 162 is included as part of this application packet. for the physician to designate physical participation categories using medical The form also contains a place for the physician to list any restrictions and/or n.

TS WITHOUT CURRENT LIMITATIONS OR RESTRICTIONS:

physical exams will likely not be required for this encampment. However, If after pplication packet CAP Form 160, CAP Member Health History Form, the n in this encampment is in question, the Encampment Commander may require the applicant’s physician using the CAP Form 162, CAP Member Physical Exam if the applicant can:

the encampment’s full program, portion of the encampment due to medical limitations, orr the activity due to medical or physical limitations.

required, the applicant will be advised and given a deadline for submission of the CAP Form 162, CAP Member Physical Exam Form. It is critical that the applicant ination and submit the CAP Form 162 prior to the established deadline in order to ment slot on the Primary List or Wait List. Early submission of the application packet ys in the awarding of an encampment slot.

ations will be made for applicants with pre‐disclosed restrictions or limitations.

ken arm cannot participate in the ropes course or cannot do pushups, but can do pment.

, enter a description of the restriction and limitations below. If "No" was selected box below and no physical examination is required.

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ADDITIONAL MEDICAL INFORMATION Information entered in the data fields on the next page will automatically fill some corresponding fields in the medical forms later in the application packet. It is important that any medical conditions entered on this page or in the medical forms of this application packet be thoroughly explained. If you answer “Yes”, explain the condition. If you answer “No”, enter “None”. Do NOT leave any comment boxes blank! Enter "None" or "NA" if there are no comments.

Allergies: (Do not list food allergies in this section) Yes No You Must Select Yes or No If you selected “Yes”, list Names of Medication or Other Allergies (i.e., bee sting, food, plants, etc.) and types of reactions. If “No” enter “None”, below.

Food Allergies, Dietary Restrictions, or Limitations: Yes No You Must Select Yes or No If you selected ”Yes”, list dietary restrictions such as food allergies, diabetes, gluten-free, lactose intolerant, etc . If “No”, enter “None”, below. Encampment staff will attempt to accommodate legitimate medical based requests; however, encampment will not be able to accommodate “life style” diet choices such as vegan, vegetarian, low fat, etc.

Past Surgical History: Yes No You Must Select Yes or No If you selected “Yes”, list all surgeries including tonsils, ear tubes, appendix, gall bladder, hernia, hysterectomy, heart, heart catheterization, bone and joint and all other surgeries. If “No”, enter “None”, below.

_______________ ___________________________________________________________ Date Signature of Parent or Guardian (Required for Minor Cadet Applicants)

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(Continue on next page) Page 6 CAP FORM 31, OCT 13 PREVIOUS EDITIONS WILL NOT BE USED OPR/ROUTING: CP

APPLICATION FOR CAP ENCAMPMENT OR SPECIAL ACTIVITY Name (Last, First, Middle Initial) CAPID CAP Grade Gender

Member Type Charter Number (e.g. GLR-MI-059) Grade in School Religious Preference

Address (Include No., Street, City, State and Zip code) Home Phone Number Cell Phone Number

E-Mail Address

Birth Month (mmm-dd-yyyy) Adult Shirt Size Height (inches) Weight (Lbs) Hair Color Eye Color

Title of Activity Location of Activity Activity Dates

Staff Position(s) Sought

Emergency Contact Information (Primary Contact) Name (Last, First, Middle Initial) Relationship Primary Phone Number

(Secondary Contact) Name (Last, First, Middle Initial) Relationship Primary Phone Number

RELEASE AGREEMENT KNOW ALL MEN BY THESE PRESENTS that I am submitting my application for the Civil Air Patrol Activities or Encampments, and I hereby volunteer entirely upon my own initiative, risk, and responsibility for an assignment to participate in this activity or encampment and with full knowledge that such activity may include: 1. Traveling by land, sea, or air in US military, commercial, or privately owned vehicle from regular place of residence tothe site of the activity or encampment, travel incident to the activity or encampment, and subsequent return to placeof residence.2. Participation in aeronautical activities as a passenger in US military or CAP aircraft.3. Being quartered and/or subsisting away from regular or normal place of residence for an extended period of time.4. Remaining with the cadet group I am assigned to at all times during the activity or encampment.5. Acting as a spokesman for Civil Air Patrol, rendering reports on the activity or encampment.6. Refraining from argumentative discussions concerning governmental policies.In consideration of its permission extended to me by the Civil Air Patrol/United States of America through its officersand agents to participate in said activity/encampment, I do hereby for myself, my heirs, executors, and administratorsrelease 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 oron account of injury to me or my property which may occur as a result of the negligence of the Civil Air Patrol/UnitedStates of America, its agents or employees during said activities/encampment or continuances thereof, as well as allground and flight operations thereto.

________________________________ _______________________________________________ Date Signature of Applicant REQUIRED NOT PARENT SIGNATURE

CAP FORM 31 REVERSE

Name (Last, First, Middle Initial) Title of Activity

RELEASE BY PARENTS OR GUARDIAN

KNOW ALL MEN BY THESE PRESENTS WHEREBY my child or ward has applied for the activity or encampment 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/encampment, 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 that 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 noted in the Medical Informationdocuments attached to this form.

3. Will follow all rules, regulations, and directives as established by the Civil Air Patrol, Inc., activity project officer or encampmentcommander, or other staff members. If not following the above mentioned rules, regulations, and directives he/she may be senthome at the discretion of the project officer, encampment commander, or activity commander 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.

Is this applicant a member of a single parent household? YES NO You must select YES or NO

If “YES” was selected, only one parent signature is required. Enter “N/A” in other parent signature line. If “NO” was selected, both parents must sign and both signatures must be witnessed. Parents may witness for each other. Minors may not witness signatures. Parent signatures are required regardless of the applicants age.

____________________ __________________________________ __________________________________ Date Witness for Father’s Signature (required) Father or Guardian Signature (required)

__________________________________ __________________________________ Witness for Mother’s Signature (required) Mother or Guardian Signature (required)

Squadron Certification. (Squadron Commander’s signature is not necessary if the activity is approved in eServices or if it is a squadron activity.) (Unit/Squadron commander’s signature is required for ALL encampment applicants). I certify that the above information is correct and that all requirements for attendance, as specified in National Headquarters Directives, will be completed by the required dates. CADET MUST HAVE COMPLETED CURRY!

____________________ _________________________________________ Date Squadron Commander (or designee) (Required) Group Certification. (Group Commander’s signature is not necessary if the activity is approved in eServices or if the activity is held within the group.) (Group Commander signature IS NOT required for Colorado Wing Cadets)

____________________ _________________________________________ Date Group Commander (or designee) Wing Certification. (Wing Commander’s signature is not necessary if the activity is approved in eServices or if the activity is held within the wing.) (Wing Commander signature IS NOT required for encampment.

____________________ __________________________________________ Date Wing Commander (or designee) (NOT REQUIRED FOR ENCAMPMENT)

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COWGF 60-80E – March 2018

CAP Colorado Wing Cadet Encampment Permission Slip 1. Information on the Participating Cadet

Cadet Name /!t GǊŀŘŜ /APID:

Unit Charter Number: Activity name: Activity Date(s):

2. Information about the Activity

Colorado Wing Cadet Encampment is a week‐long activity (11 days for cadet staff) conducted at the United States Air Force Academy (USAFA) Preparatory School and other locations at USAFA. Participants will be housed in the USAFA Prep School dormitories. Day trips to other locations away from USAFA may be conducted as part of the encampment. The supervising adult staff will include both male and female CAP Adult Members.

Name and Grade of Encampment Commander:

3. Parent’s or Guardian’s Contact information

Parent/Guardian Name: Relationship to Cadet:

Parent/Guardian Contact Number during Activity Date(s):

4. Other Documents Required to Participate

All other documents in this application packet are required. (See note below regarding CAP Form 162)

Note about CAPF 162, CAP Member Physical Exam – This form is included as part of the COWG Encampment Application Packet; however, a physical examination is not automatically required to attend encampment. A physical examination is not required unless a physical or medical condition exists that would limit full participation in the encampment activities. In this case, a physical examination is required and must be documented on CAP Form 162 and submitted with the application packet.

5. Parent’s/Guardian’s Authorization to Participate for Cadets Under age 18For cadets aged 18 or older, write “N/A”

I authorize my cadet to participate in the activity described above. _________________________________ _____________________

Parent/Guardian Signature (Required) 5ate

Please detach along the dotted line. The upper portion must be is submitted with the application. The lower portion may be retained by parents/guardians

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Helpful Information for Parents and Guardians

Activity Name: Activity Begins: Activity Ends:

Activity Location Activity Format(s)

Participation Fee: Payment Due:

Transportation is Provided during Encampment Meals are Provided during Encampment

Parents or Guardians are responsible for arranging or providing transportation To and From Encampment

This Encampment includes a designated High Adventure Activity. Your approval signature on this Permission Slip indicates your approval for your cadet to participate in the High Adventure Activity described below.

CAP Point of Contact: Phone Number:

Equipment Needed:

Encampment Website: https://cowg.cap.gov/mission/cadet-programs/cadet-encampment

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CAPF 160 JUN 13

CAP MEMBER HEALTH HISTORY FORM This information is CONFIDENTIAL and for official use only. It cannot be released to unauthorized persons. Answer all questions as accurately as possible so that the activity or encampment staff can be aware of any pre‐existing medical problems or conditions and be alert to help you. This form will also provide medical information in a case when you are unable to do so.

Name (Last, First, Middle) Grade CAPID Charter Number

Date of Birth Height (inches) Weight (Lbs) Hair Color Eye Color Gender

Allergies: List Names of Medication or Other Allergies (i.e., bee sting, food, plants, etc.) and types of reactions; please note food allergy details with dietary restrictions in the space indicated on the next page.

Do You Now Have Or Have You Ever Had Any Of The Following? Check "No" or "Yes" for each item. If “Yes” is marked in an item with multiple conditions, circle which condition applies. Explain any "Yes" answer in the remarks section or, if necessary, attach additional sheet. (Conditions not specifically listed below that have the potential to interfere with performance during the special activity or encampment should be documented in the remarks section.) Must check "No" or "Yes" for ALL condition categories. After printing, use pen and circle specific conditions for "Yes" answers.No Yes

Decreased vision, glaucoma, contacts Ear infections, perforation Difficulty equalizing ears Hearing Loss, hearing aid Allergies, nasal stuffiness Anaphylaxis, serious allergic reaction Asthma, emphysema (COPD) Ever use an inhaler Short of Breath with activityHeart Attack, chest pain, anginaHeart murmur, heart problems Congestive Heart FailureIrregular or rapid heartbeat High or low blood pressureStomach trouble, ulcersHepatitis or liver problemsDiarrhea, constipation Hernia or ruptureKidney disease or stonesProstate problems (men) Frequent urinationMenstrual cramps (women) Broken bone, joint problems

No Yes

Chronic or recurring injuries Activity or mobility restrictionsUse of cane, walker, wheelchairBack or neck pain or injuryMigraine or severe headachesDizziness or fainting spellsHead injury, unconsciousnessEpilepsy or seizure Stroke, paralysisThyroid problems (low or high) Diabetes, high or low blood sugarCancer, leukemia Blood disease, hemophilia Motion sickness Special diet, food allergiesCurrent bedwetting problemsADD (Attention Deficit Disorder)Mental illness (bipolar, other) Depression, anxiety, suicidalAdmission to hospital Other chronic medical illnessesSleep disorder, sleep apneaSerious Injury

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Circle the specific condition for any "Yes" answer. Explain any "Yes" answer in remarks on next page.

Circle the specific condition for any "Yes" answer. Explain any "Yes" answer in remarks on next page.

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CAPF 160 JUN 13

Dietary Restrictions or Limitations: (List any dietary restrictions such as food allergies, diabetes, gluten‐free, lactose intolerant, etc. Any listed item should be for legitimate medical reasons – not life style choices. Enter “None” if applicable)

Past Surgical History: (List all surgeries including tonsils, ear tubes, appendix, gall bladder, hernia, hysterectomy, heart, heart catheterization, bone and joint and all other surgeries. Enter “None” if no surgical history.)

Immunizations: In the section below, either enter the date of immunization or check “No” if no immunization.

Tetanus Booster Td or Tdap

Date: No

Hepatitis Vaccine

Date: No

Pneumonia Vaccine

Date: No

Varicella Immunization (chickenpox)

Date:

No

Influenza Vaccine

Date: No

Medication Information – Include prescription medications, supplements, over‐the‐counter medicines, herbals, creams, etc., or write “None” if no medications are allowed. Attach an additional sheet if necessary.

Name of Medication/Inhaler

Dosage/ Tablet Strength

Doses Per day Reason for Medication

Any Special dosing or Storage Instructions (i.e., as needed, with meals, must be refrigerated, etc.)

1.

2.

3.

4.

SOCIAL HIST0RY

Tobacco Use (packs per day, years smoked,

smokeless tobacco use, or enter “None” if no current or previous use.)

Occupation (student or other) Religious Preference

REMARKS (Attach additional sheet if necessary)

CONSENT FOR MINOR CADET PARTICIPATION, MEDICATIONS, TREATMENT (Consent Required for Minor Cadets Only)

I give permission for full participation in CAP programs, subject to any limitations noted herein.

My signature below evidences my consent for my child/ward to possess and self‐administer the medications listed above. I understand that there are legal limitations imposed on CAP senior members with regard to the involuntary administration

of medications to my child/ward. (Cross out this paragraph if permission is denied) In case of emergency, I understand that every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the licensed health‐care practitioner selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge exam/test results and treatment provided.

________________ _________________________________________ DATE SIGNATURE OF PARENT/GUARDIAN όwŜǉǳƛǊŜŘ for minor cadetsύ

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CAPF 160 JUN 13

Use this page for additional Medication Information or Remarks for CAPF 160 (if needed)

ADDITIONAL MEDICATION INFORMATION

Name of Medication/Inhaler

Dosage/ Tablet Strength

Doses Per day Reason for Medication

Any Special dosing or Storage Instructions (i.e., as needed, with meals, must be refrigerated, etc.)

5.

6.

7.

8.

9.

10.

CONTINUATION OF REMARKS FROM PREVIOUS PAGE (if needed)

Date and Signature of Parent/Guardian is required, below, if any information is entered on this page

________________ DATE

__________________________________________SIGNATURE OF PARENT/GUARDIAN (Required for minor cadets)

This page need not be submitted if no information is entered on it.

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CAPF 161 JUN 13 OPR/ROUTING: HS

EMERGENCY INFORMATION

(Insurance/Physician Information, Emergency Contacts, Minor Consents)

Name (Last, First, Middle Initial) CAP Grade CAPID Charter Number

Mailing Address (Number and Street) City State Zip Code

( Area Code) Home Phone ( Area Code) Cell Phone

Primary Insurance Information (If No Medical Insurance, Enter "None") Medical Insurance Company Policy Number Group Code/Number Co‐Pay Amount

$

Prescription Coverage Company Policy Number Group Code/Number Co‐Pay Amount

$

Family Physician Name Phone Number


Emergency Contact (Parent, guardian or closest relative to be notified in case of emergency)

Name Relationship to Applicant


(Area Code) Pager (Area Code) Cell/Mobile Phone (Area Code) Day Phone (Area Code) Night Phone

Unit Commander Name and Grade (Required) Unit Name

(Area Code) Unit Commander Day Phone (Required) (Area Code) Unit Commander Night Phone (Required)

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CAP MEMBER PHYSICAL EXAM FORM Last Name First Name MI CAP Grade CAPID Unit Charter Number

Note to Physician: Please complete the physical exam form below. Based on your knowledge of the individual and the information on the CAPF 160, CAP Member Health History Form (which the member should present to you), please determine a Physical Participation Category

Vital Signs Height Weight Blood Pressure Pulse Temperature Respirations

Corrected Distance Vision: Right Eye /20 Left Eye /20

Can the member hear a normal conversational voice at a distance of 6 feet with the member’s back turned to the examiner?

Yes No Physical Examination

Normal Yes No Describe Abnormalities

General Appearance

Orientation

Skin

HEENT

Heart

Lungs

Abdomen

Hernia

Neurological

Urological

Endocrine

Psychological

Joints

Back

Physical Participation Category (Check One) Category I – Unrestricted. Member is in good health, and may participate in any physical activity without restrictions.

Category II – Temporarily Restricted. Temporarily restricted from some or all physical activities due to a temporary medical condition or injury. (Specify restrictions and duration below.)

Category III – Partially Restricted. Permanently restricted from some physical activities due to a medical condition or injury that is chronic or permanent in nature. (Specify restrictions.)

Category IV – Indefinitely Restricted. Unable to participate in physical activities and is generally only capable of sedentary activity.

List Restrictions and Duration:

Certifying Physician

Name Address Phone Number

Date of Examination Signature

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This form is not required unless "YES" was selected for a Physical/Medical Limitation or Restriction on Page 4 of the application packet.


PERMISSION FOR PROVISION OF MINOR CADET OVER‐THE‐COUNTER (OTC) MEDICATION

This form may not be usable in some states due to statutes concerning who can administer medications and administration conditions. Wings with such restrictions will publish appropriate additional guidance in a supplement to CAP 160‐1.

Last Name First Name MI CAP Grade CAPID Charter Number

Over‐The‐Counter/Non‐Prescription Medications

The following over‐the‐counter medications may be administered according to package directions by CAP senior members. (After printing, cross out any medications NOT approved).

Acetaminophen (Tylenol) for fever or pain.

Ibuprofen (Advil, Motrin) for fever or pain.

Bacitracin or Neosporin antibiotic ointment to prevent infection.

Hydrocortisone anti‐inflammatory rash cream.

Calamine/Caladryl for poison ivy itch relief.

Antifungal creams and sprays for treatment of fungal rashes.

Visine eye drops for dry, irritated eye relief.

Op‐Con A eye drops for allergic conjunctivitis.

Benadryl liquid/tabs for allergic reactions.

Claritin antihistamine for seasonal allergies.

Robitussin products for relief of cough and cold symptoms.

Delsym to suppress cough.

Tums or Maalox for relief of stomach upset

Allergies My child/ward has the following allergies or reactions to over‐the‐counter medications

(list type of reaction) (Enter "None" if no allergies or reactions to over-the-counter medications)

Consent For Minor Cadet to Receive Over‐The‐Counter Medications

My signature below evidences my consent for CAP senior members to provide over‐the‐counter non‐prescription medications (such as those listed above) to my child/ward if indicated in the reasonable judgment of such senior members. I understand that I will be informed if any such medications are administered.

Date Signature of Parent/Guardian όParent Signature wŜǉǳƛǊŜŘ for all Minor Cadetsύ

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