2004 New York Wing Leadership Encampment

INFORMATION BOOKLET

Read this information booklet carefully for a clear understanding of your responsibilities. Teamwork is the key word for a successful encampment. If you do not understand or if anything in this booklet is unclear, please contact the Cadet Commander or Cadet Deputy-Commander as soon as possible. If you have received this booklet in the mail, then you are registered for the encampment and we are expecting to see you. There is a waiting list to attend IF YOU ARE NOT COMING, PLEASE CONTACT ASAP Maj Marylou Falco at (518) 785-9385 or mlf0048@aol.com!!! You may not attend the Encampment unless you are pre-registered. **PLEASE REVIEW THE REVISED CADET PACKING LIST**

TABLE OF CONTENTS

PAGE # REMARKS CADET COMMANDER COMMANDANT OF CADETS ENCAMPMENT COMMANDER REGIS TRA TION REGISTRA TRATION UNIFORM IN-PROCESSING EQUIPMENT LIST CONTRABAND LIST OR G ANIZA TION ORG ANIZATION GENERAL INF ORMA TION INFORMA ORMATION ACCOMMOD ATIONS A VAILABLE CCOMMODA AV NEAR Stratton ANG Base PARENT INF ORMA TION INFORMA ORMATION GRADU ATION AND GRADUA DEP AR TURE INF ORMA TION DEPAR ARTURE INFORMA ORMATION DIRECTIONS T O S TRA TT ON ANG BASE TO STRA TRATT TTON IMPOR TANT PHONE NUMBERS IMPORT SELF MEDICA TION RELEASE FORM MEDICATION (CENTER PULL-OUT) 10 11-12 13-14 15 15 15 16 17 18 2 3 4 5-6 7-8 9

A MESSAGE FROM THE CADET COMMANDER

First of all, congratulations on your decision to attend the 2004 New York Wing Encampment! New York Wing has long been looked upon to set the standard for leadership encampments within Civil Air Patrol, and this year will be no exception. You will be challenged as a cadet, leader and person. There will be an excellent staff to help you learn both directly through your flight staff and training staff, and indirectly by the many executive staff cadets who support the program. The encampment will seem intense, as it should be with the large amount of materials and activities to be covered in such a short amount of time. Approach your training with a positive attitude, be willing to work with your fellow in-flight cadets and you will do fine. Again, congratulations on your decision. Cadet Lt. Colonel Charles Anderson, CAP Encampment Cadet Commander

FROM THE COMMANDANT OF CADETS Congratulations! On your decision to attend this years New York Wing Leadership Encampment. Your selection by the NYW Leadership Encampment staff is a testimony to your outstanding performance and your future potential for assuming greater responsibilities. It will be leaders such as you that will keep tomorrows Civil Air Patrol strong and ready. Continue to do great things for CAP and you will be rewarded. We will reinforce the standards expected of Cadets performing duties in leadership positions. Your attitude, hard work, full use of all available time and teamwork with other cadets and the staff will significantly determine your degree of success and professional development while in attendance here. The encampment will be challenging, exciting, and meaningful. You will find this encampment to be intensive in nature as necessary, the objectives here are designed to further develop your technical knowledge, confidence, and leadership techniques and enhance your higher personal and professional standards. The standards of the New York Wing Leadership Encampment are high. We will expect you to have a positive attitude, be personally committed to success here, and obtain a mastering of the how of what we teach. Further, we expect all graduates returning to their squadron to assume and carry out their basic responsibilities and seek out higher responsibilities. I am committed to do everything within my control to ensure you successfully complete the encampment. Once again, I congratulate you on your selection to attend this years encampment. This is a momentous occasion of which you should be extremely proud for you are demonstrating your willingness to become a leader in the Civil Air Patrol. I hope your stay will be beneficial. We will endeavor to provide you with one of the most rewarding experiences. (Live the Standard). Captain Charles Miller, CAP Encampment Commandant of Cadets

A MESSAGE FROM THE ENCAMPMENT COMMANDER

Congratulations on your acceptance to the 2004 New York Wing Leadership Encampment! You are about to embark on an important step in your CAP career and personal development while taking part in the proud tradition of New York Wing Encampments that dates back to the early days of Civil Air Patrol. Throughout the Encampment, you will be challenged to grow in leadership, followership, and knowledge through hands-on experiences and instruction by cadet, senior, and military leaders. A range of exciting new opportunities will be available to us this year at Stratton Air National Guard Base including flights in C130s, a variety of Air Force guest speakers, and tours of the nearby aerospace museum. You will also learn from your peers from around the Wing. As you work together and learn from each other you will also form close friendships that will last far beyond this years encampment. As you learn, practice, and refine your leadership abilities, you will undoubtedly find that while it will not be easy, the experience before you is an extremely valuable one and that the experience and the lessons learned will stay with you for many years. Good luck and best wishes! Captain Scott Ullery, CAP NYWG Leadership Encampment Commander

REGISTRATION
Cadets are to report to the encampment on Saturday, 25 July 2004, between 1300 and 1600 hours. Cadets who are unable to report during this time must notify the Encampment Commander by Monday, 19 July 2004, to make arrangements. Cadets are to report to the PAVILION at TENT CITY, in the BDU uniform as outlined in CAP Manual 39-1. All cadets should be familiar with reporting procedures as per Leadership 2000, Vol. 1, Pages 1-9 and must employ them when reporting for in-processing. No cadets in flight are permitted to arrive early to the encampment or stay late following graduation. There is neither supervision nor any planned activities for these periods.

At registration you must have the following:

Current membership card (If you do not have a current membership card, contact Maj Marylou Falco, Encampment Registrar, prior to 19 July 2003) This booklet minus parents/guardians info section which includes contact info and driving instructions Any outstanding balance of the encampment fee of $175, checks made out to NY Wing Civil Air Patrol Your BDU uniform on your person (You must report in this uniform) All required equipment on the 2004 Encampment Equipment List

Cadets reporting without this material may not be accepted and will be required to leave the base, at their own expense. If parents are driving you, they are requested to stay at the encampment site until you have completed registration and contraband search of your luggage (see contraband list). Contraband search of your luggage will occur in the barracks, not at the registration building. Parents will take home any contraband items. Cadets driving their own vehicle to the encampment will unload their luggage in the designated area, and then drive their vehicle to the designated parking area. Cadets driving their own vehicle must surrender their keys during in-processing to the Logistics Officer for the duration of the encampment. Vehicles may not be used again until the cadet has out-processed from the encampment on Saturday 31 July.

No Contraband Items!

UNIFORM
The Civil Air Patrol uniform, when fitted and worn properly, is very important in establishing and maintaining good morale and public opinion. Wearing it correctly brings credit to you, your unit, the entire organization, and the United States Air Force. This is particularly true in New York where there are no active Air Force bases and we represent the Air Force. You will wear the uniform of the day as designated by the Commandant of Cadets (including the wear of ribbons). Uniforms will be clean and pressed, with shoes/boots shined. Shoulder cords, first sergeant diamonds, and sunglasses are not to be worn at the encampment. Articles such as watch chains, pins, jewelry, handkerchiefs, combs, keys, beepers, and radios will not be worn exposed on the uniform. Pens and pencils must be concealed except when worn in the pen compartment of the left BDU blouse pocket. Females may wear moderate make-up and clear nail polish. Earrings may be worn in accordance with CAPM 39-1. Inspections of you and your barracks area will take place several times during the encampment. Your flight staff will instruct you on how to prepare. Inspections are one way of determining the honor flight, so dont let your flight down!

2004 New York Wing Encampment Equipment List

What follows is the minimum required equipment list. ALL clothing and equipment must be marked with your last name, first initial and your 6-digit CAPID number using permanent marker or writing on waterproof tape.
Blues Uniform: 1 Summer Blue Shirt 1 Summer Blue Pants or Skirt 1 Flight Cap 1 Pair Uniform Shoes 1 Blue tab for blouse (Females Only) 1 Blues Belt with shiny chrome buckle 3 White V-NECK T-Shirts 3 Pair Black Socks (females wear with slacks) 3 Pair Neutral Shade Hose (Females only with skirt) 1 Hat Device with Backing for Flight Cap 1 Grade Insignia with Backing 1 CAP Cut-Out with Backing 1 Set Appropriate Ribbons 1 Ribbon Holder with Backing 1 Name Plate with Backing 1 set Slingshots (a.k.a. garters) (Optional) Clothing: 2 Sets of Casual Civilian Attire Civilian attire must be solid colored clothing. Nonmilitary advertising or large logos of any sort will not be permitted. 1 Light Jacket, Field Jacket, or Sweater 1 Pair Sneakers 6 Sets of Underwear (STAFF add 3 pair) 1 Pair Blue Denim Jeans or Work Pants 1 Set of PT gear (Solid Colors or Military Logos Only) 1 Modest Swim Suit 1 Raincoat or Poncho 1 Sweat Suit (optional) 1 Work clothes for painting project Barracks Items: 1 Laundry Bag 1 Small Sewing Kit Coat Hangars as necessary for uniforms 1 Solid-colored Blanket w/o any print optional 1 Sleeping bag or bedding for a Cot: 1 Pillow 1 Pillow Case Note: Temperatures may be cool. Please plan accordingly. It is recommended that bedding be solid colored without prints, however, it is not necessary if you do not already have a set. BDU Uniform: 1 Summer BDU Blouse 1 Summer BDU Pants 1 BDU Cover 1 Pair WELL BROKEN IN Uniform Boots 1 Set Blousing Bands (for BDU Pants) 1 Blue BDU Belt with Subdued Black Buckle 6 Brown T-Shirts (STAFF: 8 Black T-Shirts) 6 Pair White or military BDU Socks (STAFF Add 2 pair) 2 1-Quart Military Style Canteens to fit on web belt OR 1 Camelbak 1 Web Belt (to Attach Canteens) (Optional if using Camelbak) Toiletries: 1 Comb or Hairbrush 1 Washcloth 1 Bath Towel 1 Pair Shower Clogs or Flip-Flops 1 Hair dryer (Optional) 1 Soap Bar with Plastic Container 1 Small Container Toothpaste 1 Deodorant 1 Toothbrush 1 Small Personal First Aid Kit 1 Feminine Hygiene Products (Females Only) 1 Container Shampoo 1 small packet of Moleskin (Optional, but HIGHLY Recommended) 1 Small Container of Foot Powder (Optional) 1 Set Shaving Items 1 Small Case or Bag for Toiletries 1 Chap Stick (Optional) 1 Insect Repellent 1 Sunscreen (Optional) 1 Boot Liner eg. Dr. Scholls brand (Optional) Accessories: 1 3-Hole Punch Spiral Notebook 3 Pens 3 Pencils (with pencil sharpener) 1 Shoe Shine Kit (polish, brush, rag) 1 Flashlight with Extra Batteries and Bulb 1 Camera with Film if needed (optional) Manuals: 1 CAPM 39-1 Uniform Manual (Optional) 1 Leadership: 2000 And Beyond (Optional)
1 Drill and Ceremonies Manual (AFR 50-14) (Optional)

IN-PROCESSING Upon reporting for registration, cadets will be in-processed, which involves Registration (as described in the Registration Section), a review of any medical conditions, and a contraband search of luggage. Cadets must list all prescribed medication that they will need to have during the activity. Each cadets luggage will be inspected during in-processing. Items not on the equipment list will be sent home with the cadets parent, if available, or secured until the end of the encampment. None of the items on the Contraband List are required for the Encampment. Do not bring contraband items to the Encampment. All Contraband items will be confiscated and held for the duration of the encampment by your TAC Officer.

NOTE TO PARENTS AND GUARDIANS: A member of the encampment staff will be available to answer any questions you may have during in processing.

CONTRABAND LIST: Cadets on staff or in flight must not bring to the encampment, use, or have in their possession any of the following items: (Items will be sent home with parents or confiscated) Portable AM/FM Radios Portable Televisions Electronic Games Portable Tape Players Credit Cards ATM/Debit Cards Cash over $25.00 (No BX available, any excess will be held by the TAC Officer until the conclusion of the encampment) Pagers or Beepers Cellular Phones Non Prescription Medicines (except with a doctors note) Illegal Drugs (prescription or over the counter drugs must be registered with the medical officer) Tobacco (any form) Intoxicating Beverages (any form) Weapons (e.g. knifes) or Explosives (e.g. firecrackers) Any Flame Producing Device (including lighter, matches or flares) Food (such as snacks, soda, candy, or gum) Shoulder cords, First Sergeants diamonds, or Squadron Hats CAP Radios* (Some exceptions, see below) PDAs, Laptops, or Personal Computers (except staff with permission) Hot plates/coffee makers etc.

* Authorized VHF CAP radios and Family Radio Service (FRS) radios will be allowed by staff only.

ORGANIZATION A. STRUCTURE: The encampment is organized as a group with subordinate flights. The flight is the basic training unit of the encampment. B. CADET STAFF: Cadet staff are the only cadets who will exercise command authority. Your flight commander and flight sergeant are two highly qualified cadets who can help you with a problem or answer any questions you may have. Do not overlook the fact that any cadet or senior, whether or not they have command authority, may be able to help you learn leadership and drill. Regulations require the earned grade be worn during the encampment. Some staff may not be assigned a position equivalent to their grade (e.g. a cadet officer could be assigned as a first sergeant), therefore, colored hats are authorized to be worn by the cadet and senior staff during the encampment and are identified on the next page:

Hat Color Blue Black Red Green

Possible Staff Position Senior and Cadet Command Staff Chaplain Staff Flight Commanders First Sergeant Cadet Exec. Staff NCOs Flight Sergeants

Should You Salute? YES YES YES NO

Burgundy

Commandant of Cadets Senior Standard/Eval Officer According to Cadet Standard/Eval Officer Grade Only Senior & Cadet Training Officers Senior & Cadet Executive Staff Officers Chief TAC Officer TAC Officers Senior & Cadet Medical Staff According to Grade only

Grey

Gold White

YES According to Grade only

CAP CORE VALUES Integrity Volunteer Service Excellence Respect

GENERAL INFORMATION
1. Communications cadets will not be able to make or receive phone calls, except in the case of an emergency. We ask that no US postal mail be sent to cadets during the encampment because there is no US postal mail delivery to the encampment. Parents needing to communicate with a cadet or CAP personnel should call the number listed in the Relevant Phone Number section of this booklet. Transportation to and from Parents or guardians are responsible for providing transportation to and from the encampment. In order to get onto Stratton ANG Base, all private vehicles must be registered with the encampment. Cadets traveling by commercial bus, plane or train must notify the Senior Logisitics Officer of their arrival information by 19 July 2004. Keep this book handy with the encampment phone number, in case no one meets you at the terminal. Also, CAP does not exercise control or supervision over travel performed by members unless CAP transportation is furnished. CAP does not assume any responsibility for travel performed by members to or from special activities. Cadets who drive Privately Owned Vehicles (POVs) to the encampment will not operate the POV while at the encampment and will surrender ALL ignition keys to the encampment logistics staff upon arrival. Cadets who keep illegally hidden keys may be sent home from the encampment at the discretion of the commander. The keys will be returned during out-processing. Money The encampment fee covers all encampment expenses, there are limited opportunties to make extra purchases (no Base Exchange). It is recommended that you bring no more than $25.00 in CASH for personal expenses. Checks and money orders cannot be cashed at the encampment. Responsibility New York Wing cannot be responsible for any item of personal property brought to the encampment. It is not advisable to bring any item not included on the equipment list. All clothing and equipment must be marked with your last name, first initial and your 6-digit CAPID number using permanent marker or writing on waterproof tape. Encampment Credit Cadets who complete 80% of instruction and perform in a satisfactory manner (including conduct and attitude) will receive official encampment credit with National Headquarters CAP and a Certificate of Accomplishment. Dismissal Cadets who cannot conform to regulations or who cause a disruption at the encampment will be subject to disciplinary action including dismissal. Cadets will also be subject to dismissal for the following reasons: destroying or stealing government, CAP, or personal property; actions that jeopardize the safety of personnel; or using or having in their possession illegal drugs, intoxicating beverages, weapons, tobacco products, explosives, or any flame producing devices.

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Withdrawal If you are unable to attend the encampment, notify the Encampment Registrar before the start of the encampment. Any fees paid previously will be refunded. If the encampment Registrar is not notified prior to 19 July 04, a $25.00 cancellation fee will be deducted from the refund. Due to the large waiting list, it is important to notify the registrar directly as soon as possible. Health and Medical Personal and dental hygiene are required daily. A medical officer will be available for serious illness or accidents. Cadets are expected to be in good physical condition or have a doctors statement listing any limitations. Parents will be notified of serious injury or illness.

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10. Medications Cadets whose parents have submitted the Self-Medication Release Form (found on the last page in this booklet), will be responsible for their own medication (prescription and over-the-counter). If cadets arrive at the encampment with medications (prescription or over-the-counter) for which we do not have a signed parental release form, the cadet will not be allowed to keep the medication with them. (The release form should be brought to the encampment with the medications.) 11. Visitors Visitors, with the exception of graduation, are not allowed (a Military Support Authorization (MSA) must be on file with Stratton ANG Base for all personnel on site, prior to the start of the encampment). Any non-CAP or nonmilitary personnel who wish to stay overnight must find off-base accommodations (see listing). 12. Laundry There are no laundry facilities. It is required that cadets bring sufficient clothing that would eliminate the need to do laundry during the activity (see equipment list section of this booklet). 13. Uniforms Stratton ANG Base does not sell uniform items. Be sure to arrive at the encampment with both required uniforms. If you do not have all uniforms, please contact your squadron commander to help you get them prior to the encampment . There is no base exchange available. 14. Checklist Before leaving home for the encampment, be sure you have all required items from the Equipment List. 15. Behavior You are expected to behave in a manner that brings credit to Civil Air Patrol and to yourself. Your conduct, in or out of uniform, reflects good or bad public opinion of Civil Air Patrol. If you fail to follow encampment policy or commit acts unbecoming a CAP Cadet, you may be subject to dismissal from the encampment. 16. Limits You may not leave the encampment area without proper authorization. All areas of the base not specifically covered by orders, are off limits. If authorized outside the encampment area, you must remain in the designated area. If you wish to leave the encampment, you must go through channels to the Encampment Commander.

ACCOMODATIONS NEAR STRATTON ANG Holiday Inn 100 Nott Terrace, Schenectady, NY 12308 Phone:( 518) 393-4141 Days Inn 167 Nott Terrace, Schenectady, NY 12308 Phone: (518) 370-3297

PARENT INFO SECTION The next few pages contain information that you may need: (1) Graduation information (2) Directions to the Encampment (3) Contact Information Page (4) Self-Medication Release Form **Cadets are expected to bring this booklet to the encampment, so make sure you have detached these pages or have made copies. GRADUATION AND DEPARTURE INFORMATION Graduation will be held Saturday, 31 July 2004, at approximately 1000 hours with out-processing occurring immediately thereafter. Parents will be able to view the graduation and PassIn-Review ceremonies, which will be held at the Aero-Med Bldg. Cadets in flight will be able to depart from the BARRACKS AREA as soon as they complete their out-processing. Cadets with air, bus, or train reservations must notify their TAC Officer during the encampment of their requirements. Cadets on Staff will be staying for the staff banquet on Saturday evening and cleanup on Sunday morning. The expected departure and pick up time for staff is 1100 on Sunday, 01 August 2004.

DIRECTIONS TO STRATTON ANG BASE: From West: Take I-90 east to exit 26. Get off onto I-890 east and take it to the Erie Blvd. exit. Take Erie Blvd. For about a mile (you will pass five lights). The fifth light is at Freemans Bridge Road. Go across the bridge and through the first light. Take a right at the next light onto Maple Ave. There will be a Stewarts Shop at the intersection. Follow Maple Ave. until you see a sign for Stratton. Take a left onto Air National Guard Rd. and over the train tracks. Take a left into the base and proceed from there. From South: Take I-87 north to I-90 west. Take I-90 west to exit 25 and get onto I-890 west. Get off at the Broadway exit. Bear to the right off the ramp and go straight on Broadway to the third light (State St.). Take a left turn and then your first right onto Erie Blvd. You will go through 4 intersections with lights. The forth light is at Freemans Bridge Road. Go across the bridge and through the first light. Take a right at the next light onto Maple Ave. There will be a Stewarts Shop at the intersection. Follow Maple Ave. until you see a sign for Stratton. Take a left onto Air National Guard Rd. and over the train tracks. Take a left into the base and proceed from there. From North: Take I-87 south to the Clifton Park exit (Rte 146). Bear right after the exit going west. After a while you will come up to an intersection where Rte 146 will go to the left (there is a traffic light there). You will proceed straight through the intersection. This will become Glen Ridge Road. You will go through a few small railroad bridges and then come upon another intersection. This will be with Maple Ave. Take a left onto Maple Ave. Follow Maple Ave. until it intersects with Air National Guard Rd. Turn right onto Air National Guard Rd. and then take a left into the Base.

IMPORTANT CONTACT INFORMATION Encampment Headquarters Stratton ANG Base (After 23 July 04 - during business hours) Office: (518) 344-2488 or (518) 344-2383 Encampment Commander: Captain Scott Ullery, CAP Phone: (617) 461-3629 Email: sullery@yahoo.com Commandant of Cadets: Captain Charles Miller, CAP Phone: (724) 522-9898 Email: fdcj225@hotmail.com Cadet Commander: C/Lt Col Charles Anderson, CAP Phone (585) 599-3661 Email: letun@rochester.rr.com Encampment Registrar: Major Marylou Falco, CAP Phone: (518) 466-9479 Email: MLF0048@aol.com Encampment Web Address for further information

http://www.NYWGCadets.org

CIVIL AIR PATROL New York Wing Leadership Encampment Self-Medication Release Form

Date_________ Cadets Name: ____________________________ has been instructed in the proper use of the following medication procedures: (List all prescription medications being brought to the encampment) _____________________________________ _____________________________________ _____________________________________ (Check any over-the-counter medications being brought to the encampment.) Benadryl Other Antihistamines (e.g. Claritin) Cough & Cold Products Antacids PeptoBismal Emetrol Imodium Ibuprofen Acetaminophen Aspirin Midol Other __________________ I request that the cadet named above be permitted to carry the medication on their person or to keep same in their locker, as I consider the cadet responsible. The cadet has been instructed in and understands the purpose and appropriate method and frequency of use.

______________________________ Signature of Parent or Guardian

Please pack all medications in a bag along with this release. Any medications not listed will be confiscated for the duration of the encampment. Also, please do not send more medication than is needed for the length of the encampment.

HEADQUARTERS CIVIL AIR PATROL NEW YORK WING UNITED STATES AIR FORCE AUXILIARY 817 STEWART AVE (REAR) GARDEN CITY NY 11530 23 Feb 2004
MEMORANDUM FOR FIRST TIME IN-FLIGHT ENCAMPMENT CADETS FROM: 2004 ENCAMPMENT COMMANDER SUBJECT: 2004 New York Wing Leadership Encampment

1) Welcome . With the coming of spring it is once again time to begin thinking about the Encampment season, and I am looking forward to another excellent year. I am expecting another great turnout this year for in-flight cadets as well as cadet and senior staff. We have many exciting plans in the works for this year, and you arent going to want to miss out! It is my pleasure therefore, on behalf of the Wing Commander and New York Wing to invite you to apply now to reserve your spot at this years Encampment. 2) Dates and Location. In light of the current world climate that we continue to be faced with, I hope that everyone will understand that although your senior staff and our CAP-USAF Liaison Office are working very hard to prepare for this years Encampment, nothing can be taken for granted, and there is always the possibility that the dates and/or location might have to change between now and this summer. With this said, I am pleased to announce that the New York Wing of the Civil Air Patrol is planning to conduct its 2004 Leadership Encampment once again at Fort Drum in Watertown, New York. The Encampment will run from 24 July to 01 August for in-flight cadets including the NCO Academy. In-flight cadets are required to arrive and depart on the dates indicated there will be NO exceptions. 3) Encampment Summary. Encampments are often the most significant and worthwhile event in a CAP Cadets career. Encampments will usually focus on one of the three missions of CAP: Aerospace Education, Emergency Services, and the Cadet Leadership Program. Our Encampment in New York Wing this year will be a Leadership Encampment, and will provide the opportunity for newer cadets to learn about followership and leadership by experiencing the life of an airman for a week. New cadets will learn the basics of being a CAP Cadet through a very rigorous training schedule during the week, and by living in military barracks with their fellow cadets. More experienced cadets will have the opportunity to grow and refine their leadership skills by serving on the cadet staff in a wide variety of positions. An equipment list is provided with this mailing as a guide to the items required for those attending the encampment. 4) NCO Academy. Once again we will be offering an advanced training track for experienced cadets. The NCO Academy will offer cadets training in advanced leadership topics and provide opportunities for cadets to demonstrate their training during the Encampment. The NCO Academy is intended for cadets returning to the Encampment, however, a limited number of cadets without Encampment experience may be competitively accepted into the NCO Academy based on demonstrated experience and recommendation from a senior mentor. Applicants will secondarily be considered for basic in-flight conditions if they are not selected for the NCO Academy. 5) Application Requirements.
All Applicants Current membership card at time of Encampment Cadet Protection Training (CPPT) if 18 or older NCO Academy Prior Encampment credit C/SSgt by 10 Apr 2004 Or 18 months CAP experience w/ letter of recommendation C/MSgt by 10 Apr 2004 In-flight Cadets Curry Award (C/Amn) by 14 Jun 2003

6) Cost. The cost for this years Encampment will be $175 for each in-flight cadet. We strongly suggest that all squadrons conduct some fund-raising events during the coming spring to help defer the cost. The Encampment will accept payment by check, money order, or credit card. Checks and money orders should be included in with the application papers. Those wishing to pay by credit card should fill out and sign the credit card authorization section of the NYWF 31. Only Visa and MasterCard will be accepted. This information will be kept confidential at all times. 7) Application Forms. The NYWF 31, Application for New York Wing Encampment, dated Feb 2003, will be used by all applicants for the Encampment itself. Copies of the forms are included and will be sent to all squadrons in addition to being posted on both the New York Wing website at http://nywg.cap.gov/ and the Cadet Programs website at http://www.nywgcadets.org/enc2004/. Applications using incorrect or outdated forms may be delayed and could result in non-acceptance. All applying personnel and squadron commanders are requested to make a special effort to ensure that their forms are legible (typed forms are preferred) so that there are no errors in processing them.

8) Mailing Address. Applicants should only submit ONE copy of each application form to the Encampment Registrar. Applications sent to NY Wing Headquarters or other addresses risk being delayed and could result in non-acceptance. All signed applications must be either mailed or faxed to the Encampment Registrar at the following address: 2004 NYWG Encampment Registrar c/o Maj Mary Lou Falco 2 Mildred Lane Latham, NY 12110 3519 Fax: (775) 269-8312 9) Application Deadlines. This year we will need all squadrons to be especially attentive to the deadline so that we can better plan for the Encampment and so that we can accommodate with the rules and security measures being set forth by our host facility, Fort Drum. NO LAST MINUTE APPLICATIONS WILL BE ACCEPTED. Cadets who arrive at Fort Drum and have not been pre-registered for the Encampment WILL BE SENT HOME. The Fort Drum security policies require that we provide them with a list of who is attending prior to their arrival. As a result of increased cadet enrollment this year, we may have limited space, and applications will be accepted on a first come first served basis. Upon receipt of your application by the Encampment Registrar, you will be sent a confirmation letter to indicate anything that we are missing in order to process your application. The following are important dates and deadlines:
12 Jun 2004 POSTMARK DEADLINE In-flight cadet applications NYWF 31 NCO Academy applications NYWF 31 (Include brief (1/2 page) summary of relevant CAP and leadership experience (resume) and letter of recommendation - NCOA only) 24 Jul 01 Aug 2004 Encampment (In -Flight and NCO Academy C adets) 24 July In-flight cadets arrive between 1200 and 1600 01 August Graduation, in-flight cadet out-processing, and departure to follow immediately

10) Distribution. We are counting on everyone in our Wing to help get the word out about this years Encampment and to encourage everyone to get their applications submitted on time. We are all looking forward to having a terrific Encampment again this year. Thank you for your support!

Sincerely,

Scott G. Ullery, Capt, CAP 2004 Encampment Commander

2004 New York Wing Encampment Equipment List What follows is the minimum required equipment list. ALL clothing and equipment must be marked with your last name, first initial and your 6-digit CAPID number using permanent marker or writing on waterproof tape.

P Blues Uniform:
1 Summer Blue Shirt 1 Summer Blue Pants or Skirt 1 Flight Cap (service hat optional for officers) 1 Pair Uniform Shoes 1 Blue tab for blouse (Females Only) 1 Blues Belt with shiny chrome buckle 3 White V-NECK T-Shirts 3 Pair Black Socks 2 Pair Neutral Shade Hose (Females Only) 1 Hat Device with Backing for Flight Cap 1 Grade Insignia with Backing 1 CAP Cut-Out with Backing 1 Set Appropriate Ribbons 1 Ribbon Holder with Backing 1 Name Plate with Backing 1 set Slingshots (a.k.a. garters) (Optional) Clothing : 2 Sets of Casual Civilian Attire (Civilian attire must be solid colored clothing. Non-military advertising or large logos of any sort will not be permitted) 1 Light Jacket, Field Jacket, or Sweater 1 Pair Sneakers 9 Sets of Underwear (STAFF add 2 pair) 1 Pair Blue Denim Jeans or Work Pants 1 Set of PT gear (Solid Colors or Military Logos Only) 1 Modest Swim Suit 1 Raincoat or Poncho 1 Sweat Suit (optional) Barracks Items : 1 Laundry Bag 1 Small Sewing Kit 8 Coat Hangars 1 Small Laundry Detergent Container (Optional) 1 Solid-colored Blanket without any print 1 Set of Non-Fitted Twin Size Bed Sheets: q 1 Bottom Sheet q 1 Top Sheet q 1 Pillow q 1 Pillow Case Note: It is recommended that all linens be solid colored without prints, but this is not necessary if you do not already have a set. No sleeping bags will be allowed.

P BDU Uniform:
1 Summer BDU Blouse 1 Summer BDU Pants 1 BDU Cover 1 Pair WELL BROKEN IN Uniform Boots 1 Set Blousing Bands (for BDU Pants) 1 Blue BDU Belt with Subdued Black Buckle 7 Brown T-Shirts (STAFF: 9 Black T-Shirts) 7 Pair White or military BDU Socks (STAFF Add 2 pair) 2 1-Quart Military Style Canteens to fit on web belt OR 1 Camelbak and 1 1-Quart Canteen without cover and web belt (required for graduation)

1 Web Belt (to Attach Canteens) (Optional if using Camelbak) Toiletries : 1 Comb or Hairbrush 1 Washcloth 1 Bath Towel 1 Pair Shower Clogs or Flip-Flops 1 Hair dryer (Optional) 1 Soap Bar with Plastic Container 1 Small Container Toothpaste 1 Deodorant 1 Toothbrush 1 Small Personal First Aid Kit 1 Feminine Hygiene Products (Females Only) 1 Container Shampoo 1 Small packet of Moleskin (Optional, but recommended) 1 Small Container of Foot Powder (Optional) 1 Set Shaving Items 1 Small Case or Bag for Toiletries 1 Shower Cap (Optional) 1 Set of Makeup (Females Only, Optional) 1 Hair Spray or Hair Gel (Optional) 1 Chap Stick (Optional) 1 Doctor Scholls Shoe Liner (Optional) Accessories : 1 3-Hole Punch Spiral Notebook 3 Pens 3 Pencils (with pencil sharpener) 1 Shoe Shine Kit (polish, brush, rag) 1 Flashlight with Extra Batteries and Bulb 1 Small Container Sunscreen (Optional but recommended) 1 Camera with Film (Optional) 1 CAPM 39-1 Uniform Manual (Optional) 1 Leadership: 2000 And Beyond (Optional) 1 Drill and Ceremonies Manual (AFR 50-14) (Optional)

CONTRABAND LIST: None of the items on the Contraband List are required for the Encampment. Do not bring contraband items to the Encampment. All Contraband items will be confiscated and held for the duration of the encampment by your TAC Officer. Cadets on staff or in flight may not bring to the encampment, use, or have in their possession any of the following items:

Portable AM/FM Radios

Portable Televisions

Electronic Games Portable Tape Players Credit Cards ATM/Debit Cards Cash over $45.00 (any excess will be held by the TAC Officer until the conclusion of the encampment) Pagers or Beepers Cellular Phones Non Prescription Medicines (except with a doctors note) Illegal Drugs (prescription or over the counter drugs must be registered with the medical officer) Tobacco (in any form) Intoxicating Beverages Weapons (e.g. knifes) or Explosives (e.g. firecrackers) Any Flame Producing Device (including lighter, matches or flares) Food (such as snacks, soda, candy, or gum) Shoulder cords, First Sergeants diamonds (except Encampment First Segeants), or Squadron Hats CAP Radios* (Some exceptions, see below) PDAs, Laptops, or Personal Computers (except staff with permission)

* Authorized VHF CAP radios and Family Radio Service (FRS) radios will be allowed by staff only.

HEADQUARTERS CIVIL AIR PATROL NEW YORK WING UNITED STATES AIR FORCE AUXILIARY 817 STEWART AVE (REAR) GARDEN CITY NY 11530 23 Feb 2004
MEMORANDUM FOR ALL ENCAMPMENT STAFF APPLICANTS FROM: 2004 ENCAMPMENT COMMANDER SUBJECT: 2004 New York Wing Leadership Encampment 1) Welcome . With the coming of spring it is once again time to begin thinking about the Encampment season, and I am looking forward to another excellent year. I am expecting another great turnout this year for in-flight cadets as well as cadet and senior staff. We have many exciting plans in the works for this year, and you arent going to want to miss out! It is my pleasure therefore, on behalf of the Wing Commander and New York Wing to invite you to apply now to reserve your spot at this years Encampment. 2) Dates and Location. In light of the current world climate that we continue to be faced with, I hope that everyone will understand that although your senior staff and our CAP-USAF Liaison Office are working very hard to prepare for this years Encampment, nothing can be taken for granted, and there is always the possibility that the dates and/or location might have to change between now and this summer. With this said, I am pleased to announce that the New York Wing of the Civil Air Patrol is planning to conduct its 2004 Leadership Encampment once again at Fort Drum in Watertown, New York. The Encampment will run from 24 July to 01 August for in-flight cadets including the NCO Academy and from 22 July to 02 August for cadet and senior staff. In-flight cadets are required to arrive and depart on the dates indicated there will be NO exceptions. Cadet Staff are expected to arrive on the evening of July 22 and remain until the morning of August 2nd. Any exceptions must be approved 'in writing' by the Commandant or myself. Senior Staff are strongly encouraged to arrive and depart on these dates as well. For seniors unable to attend the entire Encampment, please be very clear on your application as to what dates you will be present. 3) Encampment Summary. For those seniors who are new to Civil Air Patrol and have not yet had the opportunity to attend an Encampment, Encampments are often the most significant and worthwhile event in a CAP cadets career. Encampments will usually focus on one of the three missions of CAP: Aerospace Education, Emergency Services, and the Cadet Leadership Program. Our Encampment in New York Wing this year will be a Leadership Encampment, and will provide the opportunity for newer cadets to learn about followership and leadership by experiencing the life of an airman for a week. New cadets will learn the basics of being a CAP Cadet through a very rigorous training schedule during the week, and by living in military barracks with their fellow cadets. More experienced cadets will have the opportunity to grow and refine their leadership skills by serving on the cadet staff in a wide variety of positions. 4) NCO Academy. Once again we will be offering an advanced training track for experienced cadets. The NCO Academy will offer cadets training in advanced leadership topics and provide opportunities for cadets to demonstrate their training during the Encampment. The NCO Academy is intended for cadets returning to the Encampment, however, a limited number of cadets without Encampment experience may be competitively accepted into the NCO Academy based on demonstrated experience and recommendation from a senior mentor. Applicants will secondarily be considered for basic in-flight conditions if they are not selected for the NCO Academy. 5) Application Requirements.
All Applicants Current membership card at time of Encampment Cadet Protection Training (CPPT) if 18 or older Senior Members Level 1 and CPPT (Cadet Protection) by 26 Jun 2004 NYWG drivers license Cadet Command Staff C/Maj or above by 20 Mar 2004 for CC, DCC, XO C/SMSgt by 20 Mar 2004 for Group 1st Sgt Cadet Staff Prior Encampment credit C/SSgt by 10 Apr 2004

NCO Academy
Prior Encampment credit C/SSgt by 10 Apr 2004 Or 18 Months CAP experience w/ letter of recommendation C/MSgt by 10 Apr 2004

In-flight cadets
Curry Award (C/Amn) by 14 Jun 2004

6) Preparatory Training Workshops . We will again be holding two staff workshops in preparation for the Encampment. The first of these weekends will be the Leadership Workshop to be held from 23 to 25 April 2004. This will be a training weekend for both cadets and senior members interested in attending as staff. In addition to studying leadership theory and practice, we will also host a mentoring workshop and will continue the staff selection process. The second weekend will be the Staff Skills Workshop. This event will be held from 25 to 27 June 2004 and will focus on preparing cadet staff and their senior member mentors for the jobs that they will fulfill during the Encampment itself. Both events will be hosted at Stratton Air National Guard Base in Scotia, NY (directions can be found on the NYWG Cadet Programs website http://www.nywgcadets.org/dirstratton.html). All attendees must also bring $12 for meals to each event. Both cadets and seniors are STRONGLY encouraged to attend these worthwhile events. Seniors who are still considering a ttending the Encampment are especially encouraged to come to the workshops to find out more about the nature of CAP Encampments and the opportunities that exist to get involved. More information will follow regarding their specifics. (The Senior Mentor Workshop will be held from 1000 to 1500.)

7) Cost. The cost for this years Encampment will be $175 per cadet, for both staff cadets and in-flight cadets. We strongly suggest that all squadrons conduct some fund-raising events during the coming spring to help defer the cost. The Encampment will accept payment by check, money order, or credit card. Checks and money orders should be included in with the application papers. Those wishing to pay by credit card should fill out and sign the credit card authorization section of the NYWF 31. Only Visa and MasterCard will be accepted. This information will be kept confidential at all times. Senior members will need to pay $10 per day up to a maximum of $50 per person. This cost will include meals and billeting in the barracks. 8) Application Forms. The NYWF 31, Application for New York Wing Encampment, dated Feb 2003, will be used by all applicants for the Encampment itself. Copies of the forms are included and will be sent to all squadrons in addition to being posted on both the New York Wing website at http://nywg.cap.gov/ and the Cadet Programs website at http://www.nywgcadets.org/enc2004/. Applications using incorrect or outdated forms may be delayed and could result in non-acceptance. All applying personnel and squadron commanders are requested to make a special effort to ensure that their forms are legible (typed forms are preferred) so that there are no errors in processing them. 9) Mailing Address. Applicants should only submit ONE copy of each application form to the Encampment Registrar. Applications sent to NY Wing Headquarters or other addresses risk being delayed and could result in non-acceptance. All signed applications must be either mailed or faxed to the Encampment Registrar at the following address: 2004 NYWG Encampment Registrar c/o Maj Mary Lou Falco 2 Mildred Lane Latham, NY 12110 3519 Fax: (775) 269-8312 10) Application Deadlines. Once again, this year we will need all squadrons to be especially attentive to the various application deadlines that are set forth below, so that we can better plan for the Encampment and so that we can accommodate with the rules and security measures being set forth by our host facility, Fort Drum. NO LAST MINUTE APPLICATIONS WILL BE ACCEPTED. Cadets who arrive at Fort Drum and have not been pre-registered for the Encampment WILL BE SENT HOME. The Fort Drum security policies require that we provide them with a list of who is attending prior to their arrival. The following is the event schedule and application deadlines. As a result of increased cadet enrollment this year, we may have limited space, and applications will be accepted on a first come first served basis. We understand that Senior Members often do not know if they will be able to get vacation time from work during the Encampment week until later in the spring. If this is the case, we encourage you to submit an application as soon as possible, and describe your situation. Cadets applying for other summer activities that might conflict with the Encampment should apply before the deadline describing their situation if they wish to be considered for a staff position. Interested senior members are also requested to contact the Commander at either captullery@townisp.com or (617) 461-6329 as soon as possible to let him know in what areas you are interested in serving. Upon receipt of your application by the Encampment Registrar, you will be sent a confirmation letter to indicate anything that we are missing in order to process your application. The following are important dates and deadlines:
20 Mar 2004 POSTMARK DEADLINE Cadet Command staff applications for C/CC, XO, DCC, 1st Sgt. NYWF 17 c for Leadership Workshop NYWF 96 with attached essay (also email essay to Commander) Hand carry NYWF 31 for Encampment to the Leadership Workshop on 23 Apr 2004 10 Apr 2004 POSTMARK DEADLINE Cadet Staff applications: NYWF 17 c for Leadership Workshop NYWF 96 with attached essay Hand carry NYWF 31 for Encampment to the Leadership Workshop on 23 Apr 2004 Cadets will not be considered for staff positions without these 23-25 Apr 2004 Activity ( Staff ) Leadership Workshop for Cadet Staff Mentoring Workshop for Senior Members Location: Stratton Air National Guard Base, Scotia, NY 12 Jun 2004 POSTMARK DEADLINE NYWF 17 c for Staff Skills Workshop for Cadets CAPF 17 for Staff Skills Workshop for Senior Members 25-27 Jun 2004 Activity ( Staff ) Staff Skills Workshop for all staff

Cost is $12 per attendee. Senior Member applications: Location: Same as for the CAPF 17 for Leadership Workshop Cadets will not be considered for Leadership Weekend. Cost is Hand Carry NYWF 31 for the command staff positions without again $12 per attendee. Encampment to the Leadership Workshop these 12 Jun 2004 22 Jul 02 Aug 2004 24 Jul 01 Aug 2004 POSTMARK DEADLINE Encampment ( Staff ) Encampment ( In -Flight C adets ) In-flight cadet applications NYWF 31 22 July 2004 - cadet and senior staff arrive 24 July In-flight cadets arrive between NCO Academy applications NYWF 31 no earlier than 1900 1200 and 1600 02 August 2004 - cadet and senior staff depart 01 August graduation, in-flight cadet (Include brief (1/2 page) summary of relevant CAP and leadership experience (resume) and no later than 1200 out-processing, and departure to follow letter of recommendation - NCOA only) immediately

11) Distribution. We are counting on everyone in our Wing to help get the word out about this years Encampment and to encourage everyone to get their applications submitted on time. We are all looking forward to having a terrific Encampment again this year. Thank you for your support! Sincerely,

Scott G. Ullery, Capt, CAP 2004 Encampment Commander

APPLICATION FOR NEW YORK WING ENCAMPMENT

NAME (Last Name, First Name, Middle Initial) JOINED CAP: MMM YY CAPID YEAR

CAP GRADE

WING

UNIT CHARTER NUMBER

REGION

ENCAMPMENT LOCATION

MAILING ADDRESS (Number and Street)

(City)

(State)

(Zip Code)

DATE OF BIRTH: DD MMM YY HEIGHT GENDER HAIR COLOR EYE COLOR

Applying As: Basic Cadet NCO Academy Cadet Staff Senior Staff This is my first encampment
SOCIAL SECURITY NUMBER (Required)

SCHOLASTIC ACHIEVEMENT High School Graduate College Post Graduate E-MAIL ADDRESS Years Years ARE YOU INTERESTED IN ATTENDING RELIGIOUS SERVICES? RELIGIOUS PREFERENCE

PRESENT OCCUPATION

(Home Phone):

YES

NO
(Business Phone):

T-SHIRT SIZE (Required)

CPPT (18 and Older Only): Completed Will be completed prior to encampment

(Cell Phone):

SENIORS ONLY: Full-Time or Part-Time Dates I will be at the encampment (Part-Time only):
Basic Cadet Encampment Contract: (You will be asked to sign this when you arrive at the encampment.)
Prior to the encampment:, if not already at that rank or higher, I will attain the rank of Cadet Airman. During the encampment: I will participate actively in all training activities, consistently performing to the highest standards for Civil Air Patrol Cadets. I will consistently adhere to the Civil Air Patrol Manual 39-1 in a constant state of readiness for inspection. I will maintain my quarters and personal gear in accordance with the Cadet Standard Operating Procedures and Supplements. My quarters and gear will be in a constant state of readiness for inspection. I will accept and complete all academic assignments in a timely, correct, and concise manner. By the conclusion of the encampment: I will be able to demonstrate satisfactory performance of basic drill movements, and customs and courtesies outlined in AFMAN 36-2203 and the Encampment OIs. I will be able to perform as part of a team, cooperating with and supporting other members of the team.

PAYMENT OF ENCAMPMENT FEES: I have included payment of $ If Paying by Credit Card Account Number Name on Credit Card:

in the form of:

Cash: Visa

Check:

Money Order:

Credit Card:

MasterCard

Expiration Date: (MMM YY)

Signature of Card-holder
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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 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 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 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.

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 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 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.

DATE

WITNESS FOR FATHERS SIGNATURE

FATHER OR LEGAL GUARDIAN

WITNESS FOR MOTHERS SIGNATURE

MOTHER OR LEGAL GUARDIAN

SQUADRON CERTIFICATION
I certify that the above information is correct and that all requirements for attendance will be completed by the required dates.

SQUADRON COMMANDER

WING CERTIFICATION (Required for applicants who are not members of New York Wing)
This applicant has my permission to attend the NYW Encampment.

WING COMMANDER

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MEDICAL INFORMATION - TO BE COMPLETED BY ALL APPLICANTS

NAME OF PARTICIPANT (Last Name, First Name)

CAPID

DO YOU CURRENTLY USE ANY MEDICATION? (Including eye drops)

NO

YES (List any medication taken and the reason in the remarks section.)

HAVE YOU HAD OR BEEN INVOLVED IN AN ACCIDENT IN THE PAST 2 YEARS?

NO

YES (Explain the extent of your injuries and treatment required in the remarks section.)

HAVE YOU HAD OR HAVE NOW ANY OF THE FOLLOWING? (If yes is answered on any items, please explain why in the remarks section with dates and physician(s) consulted (if any). Items not specifically noted below having the potential to interfere with performance during the special activity or encampment should be documented in the remarks section.) NO NO NO NO NO NO NO NO NO NO YES YES YES YES YES YES YES YES YES YES Frequent or severe headaches Dizziness or fainting spells Unconsciousness for any reason Eye trouble, excluding glasses Hay fever Sugar or albumin in urine Heart trouble High or low blood pressure Stomach trouble Asthma NO NO NO NO NO NO NO NO NO NO YES Ear infections YES Rupture YES Positive TB skin test YES Epilepsy or fits YES Kidney stones or blood in urine YES Motion sickness YES Nervous trouble of any sort YES Any known allergies YES Any drug or narcotic habit YES Chronic or recurring injuries NO NO NO NO NO NO NO NO NO NO YES Chronic diseases like Diabetes or Bronchitis YES Girls only - Menstrual cramps YES Other illness or accidents YES Military rejection or medical discharge YES Rejection for life insurance YES Admission to hospital YES Record of traffic convictions YES Record of other convictions YES Attempted suicide YES Medical treatment within the past 5 years other than regular office visits or physicals

IMMUNIZATIONS

FAMILIY PHYSICIAN (Name, address, and phone number)

INSURANCE INFORMATION Medical Company Liability Company

Policy Number

Policy Number

EMERGENCY ADDRESSEE - PARENT, GUARDIAN, OR CLOSEST RELATIVE TO BE NOTIFIED IN CASE OF EMERGENCY Name Relationship

Address

Day Telephone

Night Telephone

REMARKS

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FORT DRUM RELEASE AND HOLD HARMLESS AGREEMENT [EVERYONE MUST SIGN]
1. PRIVACY ACT STATEMENT: Personnel data is solicited under authority of 10 USC 3013 and AR 27-40. The information is for use to determine eligibility for voluntary participation in the potentially hazardous activity of Cadet training in the area of the Fort Drum Military Reservation. Disclosure of requested information is voluntary, but failure to disclose all or any part of it may result in denial of permission to participate in such activities which will occur during the period of the New York Wing Civil Air Patrol encampment. 2. PERSONAL DATA:

NAME: ADDRESS: PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: RELATIONSHIP: ADDRESS: TELEPHONE: CITY: STATE: CITY: STATE:

AGE: ZIP:

ZIP:

3. DECLARATION: I (or my children) desire to participate at my own risk in the potentially hazardous activity described above. I represent that I will take all safety precautions necessary thereto, assuming sole and full personal responsibility for ensuring that all reasonably foreseeable safety requirements are met to my personal satisfaction prior to my active participation in such activity. I state that I am (or my child) is in good health, physically fit to engage in this activity, and have no known medical condition which could foreseeably jeopardize my safety during such participation or be aggravated by such participation. As a condition precedent to my being permitted to engage or participate in such activity, I, both personally and on behalf of my child, hereby forever release, acquit, discharge, indemnify, and hold harmless the United States, its agents, officers, and employees, from any and all causes of actions, including personal injury, illness, death and property damage, costs, charges, claims, demands, and liabilities of whatever kind, name or nature in any manner arising out of or in connection with my participation (or my childs participation) in the indicated potentially hazardous activity. This is not a waiver of any medical benefits or treatment, which I am entitled to receive as a soldier or as a family member of a soldier. If the above listed person is under the age of 18 years old, I consent to having my child/ward participate in this activity.

DATE

SIGNATURE OF PARENT OR GUARDIAN (OR INDIVIDUAL IF OVER 18 YRS)

PRINTED NAME OF PARENT OR GUARDIAN

FORT DRUM PERMISSION FOR EMERGENCY MEDICAL TREATMENT (IF UNDER 18 YEARS OLD)
1. PRIVACY ACT STATEMENT: Personnel data is solicited under authority of 10 USC 3013 and AR 27-40. The information is for use to determine eligibility for voluntary participation in potentially hazardous activity of Cadet training in the area of the Fort Drum Military Reservation. Disclosure of requested information is voluntary, but failure to disclose all or any part of it may result in denial of permission to participate in such activities which will occur during the period of the New York Wing Civil Air Patrol encampment. 2. PERSONAL DATA: (SEE ABOVE) 3. DECLARATION: I grant permission for my child/ward to receive emergency medical treatment for injuries arising out of or connected with the potentially hazardous activity described above.

DATE

SIGNATURE OF PARENT OR GUARDIAN

PRINTED NAME OF PARENT OR GUARDIAN

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