ࡱ> #` ʳbjbj ). 4< tDDDhEEc2F8$L$L$L$LqMEO1Pxhbjbjbjbjbjbjb$dhGgrb $TOM"qM$T$Tb $L$L+gcXXX$Tp $L $LhbX$ThbXX:p], ]$LF p. DT@] _\}c0c]RgTg]g ^PIQrXQ\R PPPbbXPPPc$T$T$T$T** 4 "8  cc APPLICATION FOR CADET MEMBERSHIPCHARTER NUMBERSOCIAL SECURITY NUMBERIN CIVIL AIR PATROL (Type or print.) FORMTEXT       FORMTEXT      LAST NAME - FIRST NAME - MIDDLE INITIAL  FORMTEXT       formcheckbox  MALE formcheckbox  FEMALEHEIGHT  FORMTEXT    WEIGHT  FORMTEXT    BLOOD TYPE formdropdown DATE OF BIRTH DAY MONTH YEAR formtext      MAILING ADDRESS (Number and Street)  FORMTEXT      APT  FORMTEXT     CITY  FORMTEXT      STATE  FORMTEXT   ZIP CODE  FORMTEXT      HOME PHONE (formtext    ) formtext      E-mail address (This address may be used to contact you concerning CAP events and other membership information) CELL PHONE  FORMTEXT       Parent or Guardian (Name and address) formtext       formtext      RELATIONSHIP:formdropdown PHONE: (formtext    )formtext      SCHOOL PRESENTLY ATTENDING (NAME AND ADDRESS) formcheckbox  Check here if Home Schooled  FORMTEXT      GRADE  FORMTEXT      MEMBER MOST RESPONSIBLE FOR YOUR JOINING CAP (OPTIONAL : For recruiting campaign purposes) NAME CAPSN CHARTER NUMBER  FORMTEXT        FORMTEXT        FORMTEXT      To help us better serve our members, please tell us how you heard about Civil Air Patrol (check all that apply): FORMCHECKBOX  Air Show  FORMCHECKBOX  CAP Member  FORMCHECKBOX  Friend  FORMCHECKBOX  Magazine  FORMCHECKBOX  Family Member  FORMCHECKBOX  CAP Exhibit  FORMCHECKBOX  School  FORMCHECKBOX  Radio  FORMCHECKBOX  Television  FORMCHECKBOX  CAP Website  FORMCHECKBOX  CAP Volunteer Magazine FORMCHECKBOX  Other (please name): formdropdown BACKGROUND INFORMATION:A. CITIZENSHIP 1) Are you a citizen of the United States? formdropdown  2) Are you an alien admitted for permanent residence? formdropdown  (Must possess current alien registration receipt card [Form I-151 or I-551]).B. IDENTIFICATION GROUP formcheckbox  WHITE formcheckbox  BLACK (NOT OF HISPANIC ORIGIN) formcheckbox  HISPANIC formcheckbox  ASIAN/PACIFIC ISLANDER formcheckbox  AMERICAN INDIAN/ALASKAN NATIVEC. PRIOR CAP MEMBERSHIP (WRITE NONE IF APPROPRIATE) formdropdown  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT      Old Charter NumberMembership Date (From)Membership Date (To)Highest Cadet Award EarnedI hereby make application for cadet membership in Civil Air Patrol. I pledge that I will serve faithfully in the Civil Air Patrol Cadet Program and that I will attend meetings regularly, participate actively in unit activities, obey my officers, wear my uniform properly, and advance my education and training rapidly to prepare myself to be of service to my community, state, and nation.APPLICANT SIGNATUREDATE  FORMTEXT      This application has my approval. I understand that my child may be flying in CAP aircraft and participating in vigorous outdoor activities. I agree to help support my child s efforts to attend official Civil Air Patrol functions and activities. I understand that if my child receives a free uniform and withdraws from the program during the first year that I assume responsibility for this uniform on behalf of my minor child. For information on how CAP supports parents see cap.gov/parents. I understand if my child receives a free uniform and withdraws from the program during the first year that I assume responsibility for this uniform on behalf ofmy minor child and the uniform must be returned or replaced.PRINT PARENT OR LEGAL GUARDIAN FULL NAME  FORMTEXT      SIGNATUREDATE  FORMTEXT      To be completed by commander or designated representative: I certify that the applicant is accepted as a member of Civil Air Patrol subject to approval by higher headquarters with National Headquarters as the final approving authority. Membership becomes effective when this application is processed by National Headquarters and the individual s name appears on the National Headquarters database.UNIT NAME  FORMTEXT      PRINT FULL NAME  FORMTEXT      SIGNATUREDATE  FORMTEXT      A NOTE TO THE NEW CADET Congratulations on joining Civil Air Patrol! To fly in CAP aircraft and be credited for achievements in the Cadet Program, your application must be processed by CAP National Headquarters. So please rush this application and your check for dues to: NATIONAL HEADQUARTERS CAP/DP 105 S. HANSELL ST. MAXWELL AFB AL 36112-6332CAP FORM 15, DEC 06 PREVIOUS EDITION MAY NOT BE USED AFTER 28 FEB 07 OPR/ROUTING: DP HEALTH CERTIFICATE PARENTS EVALUATION The activities in which your child will participate while a member of CAP are generally comparable to those experienced in high school, including physical education activities. To assure the fullest degree of pleasure and success in Civil Air Patrol, the cadet should be healthy, both physically and mentally. If you mark NO in all the boxes below, your cadet will be placed in a Physical Fitness Category I, and will not require a physical examination. It you mark YES in any box, an examination by a physician is required. YES NO formcheckbox  formcheckbox  FREQUENT OR SEVERE HEADACHES formcheckbox  formcheckbox  DIZZINESS OR FAINTING SPELLS formcheckbox  formcheckbox  UNCONSCIOUSNESS FOR ANY REASON formcheckbox  formcheckbox  EYE TROUBLE (not correctable with glasses) formcheckbox  formcheckbox  HEART TROUBLE formcheckbox  formcheckbox  CHRONIC OR RECENT EAR TROUBLE formcheckbox  formcheckbox  HIGH OR LOW BLOOD PRESSURE formcheckbox  formcheckbox  SIGNIFICANT ABDOMINAL TROUBLE (INCLUDING HERNIA) UNLESS CORRECTED formcheckbox  formcheckbox  SUGAR OR ALBUMIN IN URINE formcheckbox  formcheckbox  EPILEPSY formcheckbox  formcheckbox  MENTAL OR NERVOUS DISORDER formcheckbox  formcheckbox  DRUG OR NARCOTIC HABIT formcheckbox  formcheckbox  EXCESSIVE DRINKING HABIT formcheckbox  formcheckbox  REJECTION FOR LIFE INSURANCE formcheckbox  formcheckbox  ASTHMA formcheckbox  formcheckbox  ALLERGIES formcheckbox  formcheckbox  OTHER LIMITATIONS I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE HEALTH OF THE APPLICANT IS AS SHOWN ABOVE.PARENT OR LEGAL GUARDIAN SIGNATUREDATE formtext      PHYSICIAN S CERTIFICATE (Required if  YES was marked in any box above) I certify that I have examined the applicant whose name appears hereon and that he/she does not possess physical limitations that would preclude participation in Civil Air Patrol as explained in the above parents evaluation. UNRESTRICTED: Physically capable of full participation. TEMPORARILY RESTRICTED: Medical condition or injury is temporary in nature. PARTIALLY RESTRICTED: Indefinitely or permanently restricted from a portion of the program. PERMANENTLY RESTRICTED: Medical condition or injury is chronic or permanent in nature and individual is restricted from all Civil Air Patrol physical activities.PHYSICIANS SIGNATUREDATEPHYSICIANS ADDRESSPHYSICIANS PHONECAP FORM 15, DEC 06 REVERSE Civil Air Patrol Cadet Uniform Program Instructions This program provides an opportunity for a new cadet to receive, at no cost to the cadet, a basic blue Air Force uniform, provided the unit commander approves the request and funds continue to be available in the program. Cadets are responsible for purchasing the CAP accessories (name tag, ribbons, grade insignia, hat device, etc.) required for proper wear of the uniform. 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Free uniform items must be returned (or replaced, if lost or damaged) to the local CAP unit in the event the cadet withdraws from the cadet program within the first year of membership. The parent/guardian assumes the responsibility on behalf of the minor child. The unit commander will make every reasonable effort to retrieve these uniform items. Uniforms received under this program will not be sold, rented or given to anyone other than CAP cadets. Ordering Instructions You must use e-Services (www.capnhq.gov) to order your uniform under this Cadet Uniform Program. Once your membership application is processed, you will receive a membership card with your CAPID number. You should use the CAPID to log into e-Services, or you may use your Social Security Number. Click on the First time users link and follow the instructions. Once you have established your account, log into e-Services and look for the Cadet Uniform link on the left side. Click the Cadet Uniform link and follow the instructions to order a cadet uniform under this program. If you need help with sizing information, click on the male or female sizing charts. Commanders and Deputy Commander are authorized to input orders on behalf of the cadet. Important Numbers To check the status of your Cadet Membership application, contact Membership and Development (MDV) at 1.877.227.9142. To check the status of your uniform order, contact the Army Air Force Exchange Service (AAFES) at 1.210.674.0190. Be prepared to provide the batch number and your CAPID . To exchange a uniform item(s), return to: Lackland Military Clothing Sales Store 1520 Kirkland, Bldg 6659 San Antonio, TX 78236 Questions about your exchange? Call 1.210.674.0190. You will need to include CAPID, name, address, phone number, and the size(s) you need. Commanders Actions You are responsible for approving the cadets order. Log into e-Services and follow the Cadet Uniform Approval link in your restricted applications (look at the right side of your screen). Commanders will see a link under the Approvals section of Commanders Corner as well. Uniform orders placed by the commander or deputy commander on behalf of the cadet are automatically approved. You are responsible for administering this program. As a leader, you can go into e-Services and follow the Cadet Uniform>>Reports link in your restricted applications (look at the right side of your screen), to run a Cadet Uniform Program report at least quarterly. This report shows all cadets who should have received a uniform within a year from the date that the report was run. This report can help you as you verify that the cadets received their uniforms or alert you to those who have not. Also, use this report to account for the uniforms as required (see CAPR 67-1 for details). File these reports in the Pt II of the Property File. Questions? Contact NHQ CAP/LGS at 1.877.227.9142, ext 264, or e-mail logeqp@capnhq.gov.     Instructions Revised Aug 08 ٭ڭ3ɮBdf|ƳdzȳɳʳἝ|x|x|x|xtmtimtxhp hBghjhjh9/jh9/U hohaZ#hMhMCJOJQJ\^JaJ hMhMCJOJQJ^JaJhoCJOJQJ^JaJ hMhoCJOJQJ^JaJ&hoho5>*CJOJQJ^JaJ hohoCJOJQJ^JaJh2CJOJQJ^JaJ%h@"6Bdzȳɳʳ"gd]#gdBg"  Vgdoxgdoxgdo2&P:p/ =!8"8#$% 2&P:po/ =!8"8#$% 61hP:po/ =!"#8$8% $$If!vh565 5 #v6#v #v :V l0565 5 / / 4TDADDRESSEnter your permanent address DEnter your permanent address $$If!vh565 5 #v6#v #v :V l0565 5 / 4ytBgTDEnter your permanent address tDeCheck3tDeCheck4D HEIGHT0Height in INCHES D WEIGHT0Weight in POUNDS Df Bloodtype  O+O-A+A-B+B-AB+AB-D DOBd-MMM-yyEnter your date of birth $$If!vh55n55585#v#vn#v#v8#v:V l055n55854TDEnter your permanent address DAPTEnter apartment number DCITYEnter your permanent cityDSTATE(Enter your permanent 2-letter state codeDZIPEnter your permanent ZIP code DAREACODE&Enter your home phone number area codeDPHONE UppercaseEnter your home phone number$$If!vh5M555*585#vM#v#v#v*#v8#v:V l805M555*585/ 4ytBgTDREF_NAME9Name of person who referred you to Civil Air Patrol, Inc.$$If!vh5'#v':V lJ05'4ytBgTvDKIN_NAMEName of next of kin|D KIN_ADDRESSAddress of next of kin6DfKIN_TYPE&Choose the relationship of this person PARENT GRANDPARENTSIBLINGOTHERFRIENDSPOUSE$$If!vh5H5 #vH#v :V l40+5H5 / 4f4TDKIN_AC&Enter your home phone number area codeD KIN_PHONE UppercaseEnter your home phone number$$If!vh5H5 #vH#v :V l40+5 5 / 4f4TtDeCheck3DSCHOOL/Name and address of school you presently attendD SCHOOL_GRADE!Highest grade completed in school$$If!vh5"5#v"#v:V l05"5/ 4TD9Name of person who referred you to Civil Air Patrol, Inc.D CAPSNCAPSN of referring member D REF_CHARTER#Charter number of referring member $$If!vh5'#v':V l*05'/ 4ytr&T$$If!vh5'#v':V l05'/ / 4TxDeCheck180xDeCheck182xDeCheck183xDeCheck184xDeCheck185xDeCheck186xDeCheck187xDeCheck188xDeCheck189xDeCheck189xDeCheck191$$If!vh55#v#v:V l40+5/ / / 4f4ytr&TxDeCheck1906DfKIN_TYPE&Choose the relationship of this person PARENT GRANDPARENTSIBLINGOTHERFRIENDSPOUSE$$If!vh5505 #v#v0#v :V l40+55+5 / / / / 4f4yt^jT$$If!vh5'#v':V l05'/ / 4TDfCITIZEN Are you a United States Citizen? 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