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Michigan Wing
Search and Rescue Academy
2015
Aircrew Survival Course
Registration Packet
10 July – 12 July 2015
TABLE OF CONTENTS
Letter from the Commandant ..……………………………………………………………………………………………………………………………………… 3
Important Information ………………………………………………………………..………………………………………………………………………………… 4
Introduction ………………………………………………………………………………………………………………………………………………………………….. 4
MIWG SAR Academy History …………………………………………………………………………………………………………………………………………. 4
Student Requirements and Course of Instruction …..……………………………………………………………………………………………………… 5
General Information ………………………………………………………………………………………………………………………………………………….… 6-7
Check-In and Graduation ………………………………………………………………………………………………………………………………………………… 8
Attachment A – Cost and Food Plan ….……………………………………………………..…………………………………………………………………9-10
Attachment B – Training Checklist/ Link Page …………………………………………………………………………………………………………….... 11
Attachment C – Student Packing List …………………………………………………………………………………………………………………………12-14
Attachment D– Registration checklist …………………………………………………………………………………………………………………………… 15
CAPFs 31, 160 series ………………………………………………………………………………………………………………………………..…………………. N/A
Page 2
LETTER FROM THE COMMANDANT
To all SAR Academy Students,
Thank you for your interest in the 2015 Michigan Wing Search and Rescue Academy. SAR Academy is designed to help
meet the emergency services mission of Civil Air Patrol by providing better trained and qualified personnel to support
our operational missions.
This booklet explains what is expected of you and provides guidelines for your behavior while at the Academy. We have
high standards of behavior and participation – we expect you to work hard – and have a good time while doing it!
SAR Academy operates in a professional atmosphere while still adhering to military customs. The emphasis is on
emergency services skills with the assumption you’re already knowledgeable in your military skills. We will be guests at
Camp Grayling and as guests on their facility, the behavior of our students will reflect directly on SAR Academy, Michigan
Wing, and Civil Air Patrol. All students are expected to adhere to standards of behavior that will bring credit to our
organization.
SAR Academy is a demanding activity. As in actual missions, there are challenges to your endurance and mental
problem solving. It is our intent to help prepare you academically as well as mentally and physically for the challenges
that may await you when you serve others in emergency situations. Please do your part to prepare by drinking more
water during the weeks prior to SAR Academy.
If you have questions, don’t be afraid to ask. Depending on which course you are participating in, you will have instructors
and a Senior Course Commander. They‘re all willing to help you and answer your questions. As the Commandant, I am
also available if you have a problem or questions that don’t seem to be receiving an answer. Please remember to start
your questions at the lowest level in the chain of command.
SAR Academy will give you a great opportunity to advance your emergency services skills, share/gain knowledge of
emergency services, make lasting friendships with students and staff from across Michigan Wing, and you will probably
have some fun in the process.
Congratulations on choosing to be a part of an excellent Academy! I look forward to meeting you.
Antonio C. Gutierrez, Major, CAP
Commandant
2015 MIWG SAR Academy
Page 3
Dates:
Location:
Mission Base/EOC:
Commandant:
Questions:
Webpage:
Facebook page:
IMPORTANT INFORMATION
10 July – 18 July 2015 (NOTE: Aircrew Survival is 10-12 July)
Camp Grayling, Grayling Township, MI 49739 (Joint Maneuver Training Center)
Camp Grayling, Training Area 4/Howes Lake (STA4), and Training Area 19 (STA19)
Maj Tony Gutierrez
Email to [email protected]. They will be directed to the proper staff member.
www.saracademy.net
“MIWG SAR Academy”
INTRODUCTION
Thank you for your interest in the 2015 MIWG SAR Academy. It is one of the most physically demanding, academically
stringent, and rewarding activity that Civil Air Patrol has to offer. Whether you are a senior member or cadet, you will be
provided with hands-on SAR, field leadership experience, and survival training.
This Academy takes place in the wilderness with no modern conveniences available to the students. Conditions are
primitive, with no indoor plumbing and no electricity. Bathing will be provided and will be available in a Lake. Sleeping
will be only in tents, or constructed shelters regardless of the weather experienced. Weather can be dry or rainy, with
temperatures changing from the high 90's to 40 degrees within hours. All cell phones will be collected at sign in, and
students may only call home in the event of an emergency. The knowledge that you will gain about yourself, the CAP
Emergency Services Program, and search & rescue will remain with you for the rest of your life.
The Academy is very demanding, both physically and mentally. The curriculum and standards of the Academy’s training,
facilities, and equipment are constantly evaluated for improvements and needed updates as funding allows. The staff
are all volunteers and consist of cadets and senior members. They will teach and train you for nine full days. You are
expected to do your best for those nine days!
HISTORY OF SAR ACADEMY
The Michigan Wing Search and Rescue Academy began in 1994 when a small group of members recognized the need for
consistent, quality training in the field of Emergency Services. They then designed a comprehensive school that could
provide that training within the course of a week. Lead by the efforts of then Captain Sheila Cerny, they chose a location
deep in the heart of the Huron National Forest that is unparalleled for teaching woodsmanship, navigation, and practical
leadership skills. Long before task training was introduced by National Headquarters, the founders of SAR Academy
created their own by deciding what knowledge was necessary for a Ground Team Member and then devising a method
of testing that knowledge after it was taught.
SAR Academy began with only one course, the Basic Course, which was designed to take members who had no previous
ES training and provide them with all classroom and practical training necessary for them to become Ground Team
Member Qualified. Over the next few years, SAR Academy continued to grow and expand to meet the increasing needs
of its returning student population. By 1997, three new courses had been added: the Advanced Course, which provides
more in-depth and thorough Ground Team Member training, the Medic Course, which provides students with
wilderness first aid training, and the Ground Team Leader Course. In 2010 a Senior Course was started to train senior
members to become ground team member qualified. 2012 marked another new course for SAR Academy. The Aircrew
Survival Course was started to train aircrew members in survival and much more.
SAR Academy has had more than two hundred fifty graduates since its inception in 1994. Many of those graduates have
gone on to successful careers in the military, in aviation, and in the business world. Still others remain within our
program, diligently giving back to new students what knowledge they received themselves as students many years ago.
As SAR Academy approaches its 21st year of operation, it has evolved into an Academy of utmost quality, having
benefitted from the influence of the hundreds of staff members and students who have helped to make it what it is
today.
Page 4
AIRCREW SURVIVAL COURSE
Course Overview
This course deals specifically with basic survival training in a summer environment, including a field exercise as well as
many practical evolutions. Attention is directed toward building the student’s confidence through realistic
demonstrations, simulations, hands-on training sessions, and exposure to equipment found in aviation emergencies.
Together the aircrews will explore the essentials for surviving a hard landing, learning how to keep fear in check, and
problem solve their way out using what they have available. This fun and educational experience is sure to leave you
with a sense of confidence and understanding of survival techniques that may someday save your life.
Course Objectives
 The course’s objective is to prepare students with the mental and physical techniques to enhance their survival
in aviation emergencies.
Course Requirements
 SENIORS: Completed Level I and the new Cadet Protection Senior Basic Course
 CADETS: Must be 18 years of age
 Current Aircrew Qualifications
 Current CAP membership
 Complete the required CAPF 31 (with proper signatures-unit cc and parents)
 Must be safety compliant
 All CAP Health forms ( 160,161)
 You must supply your own meals for the three days of the course as shown in attachment A.
 You must arrive with all of the equipment listed on the packing list in attachment C.
Course Graduation Requirements
 Attend all three days of the course and successfully accomplish all of the items in the Aircrew Survival Task
Guide.
Point of Contact
Aircrew Survival Course Commander: Capt. Bill Ross, [email protected], 269-924-7300
Aircraft Survival Course Deputy Commander: Lt. Col. Jason Sherwood, [email protected], 231-638-1561
Page 5
GENERAL INFORMATION
TRANSPORTATION
Students may drive to the Academy in a privately owned vehicle (POV). Upon arrival at SAR Academy, the vehicle will be
parked in a designated area. During the Academy, seniors will not be allowed to operate their vehicles during the
Academy without permission from the Commandant. If a senior needs to enter their vehicle for any reason during the
Academy, you must have permission of your Course Commander.
PERSONAL PROPERTY
Make sure you check prior to departure to ensure you have all the required items on the packing list for your course.
The packing list for the Academy is located in Attachment D along with additional equipment required for each course in
attachment E. If you arrive to SAR Academy without the items listed on the packing list, you will not be allowed to check
in until you do. There are several locations to purchase missing items: Base Store at Camp Grayling or Glen’s Market and
K-Mart in downtown Grayling.
SAR Academy and its staff are not responsible for loss or theft of your personal equipment or property. You need to take
care of your property. It is suggested that you leave valuables and jewelry at home. LABEL ALL PROPERTY.
Please check your equipment and items carefully before departure. Any lost items that are found and identifiable at the
close of the Academy will be shipped to you at your expense if it can be identified.
BRING ONLY THE ITEMS LISTED ON THE PACKING LIST. Do not bring any extra equipment/gear.
MEDICATIONS
All medications, prescription or over-the counter (OTC), will be logged with the health services officer. All STUDENTS are
expected to manage their own medications. If you have any specific requirements, please be sure to coordinate with the
Commandant prior to arrival, or if it is a last minute change, the health services officer on arrival.
HEALTH
A safety officer is available along with several EMTs, Paramedics, and other trained first aid personnel. First aid will be
provided for routine and minor illness or injury. There is a county hospital in the vicinity for any medical problems. In the
event of serious illness or injury, every attempt will be made to notify your parent/guardian/emergency contact as soon
as possible.
Let the Health Services Officer know of any health issues or problems you are encountering. Students are expected to
bring supplies to help themselves (blister kits, small quantities of OTC meds), but if you require assistance please let the
Health Services Officer know.
CELL PHONES
Senior members who are students at the Academy will be allowed to carry their cell phones. If you need to carry it, it
must be on vibrate and only be used in emergency situations (family, work, emergency, etc).
RELIGIOUS SERVICES
For those students who wish to attend a religious service during SAR Academy, a non-denominational service is currently
in the planning stages. We do not have a chaplain on staff nor do we have a church in the field, however, we will try our
best to accommodate your needs.
Page 6
MEALS
Students will eat all three meals per day and drink plenty of fluids. Refrigerators and microwaves are NOT available.
Students are responsible for ALL of their meals.
SLEEPING ARRANGEMENTS
Students will be assigned a bunk in the barracks.
WATER
We guarantee that at all times there will be sufficient water for our students. Safety is our highest priority. The Course
Commanders will monitor and ensure that all students are drinking plenty of water each day of the Academy.
CONTIGENCY PLANS
All SAR Academy Staff members have a contingency book. This book is used as guidance on what to do in the event of
an emergency. All staff has been trained in what to do and how to do it. Each day, the Duty Officer will contact Camp
Grayling’s Range Control to advise on our status. We are also in contact with the local Fire Department, US Forest
Service, and State Police. They have been orientated with our mission base and know how to get in contact with us if
the need arises.
EMERGENCY CONTACT
An EMERGENCY phone number to reach our SAR Academy Emergency Operations Center (EOC) will be provided to
students, staff, and parents on arrival and will be posted on our web site after the Academy begins.
Page 7
CHECK IN AND GRADUATION
SAR ACADEMY LOCATION
Camp Grayling
Joint Maneuver Training Center
Grayling Township, MI 49739
Note: When typing it into google maps, type “Camp Grayling, MI”
TRAVEL TIME
Depending on your route, plan on 3.5 hours if traveling from Detroit (East); plan on 3 hours if traveling from Muskegon
(West); plan on 3.5 hours if traveling from South Michigan (South).
CHECK IN
Sign-in will take place on Camp Grayling at Bldg 202M. Aircrew Survival students shall arrive by 0900hrs and no later
than 1000hrs on Friday, 10 July 2015. You will be required to show your CAPID to the Main Gate at Camp Grayling.
DIRECTION TO CHECK IN______________________________________________________________________________
After passing through the main gate, look for 1st Street (First Street) on your right. Turn RIGHT onto 1st Street. Then make
a LEFT on KITCHEN Road. Look for building 202M (which will be on your right). Report to bldg. 202M.
GRADUATION
The ceremony will start at 1800hrs on Sunday, 12 July 2015. Location TBD.
DIRECTIONS TO GRADUATION
After passing through the main gate, continue on HOWE Road. You will pass 1st Street, 2nd Street, and 3rd Street. The
following intersection will be 4th Street. Turn RIGHT onto 4th Street. The parade field will be on your left. Upon arrival to
the parade field, you will be directed where to park.
Main Gate
Lake Margrethe
1st Street
Bldg 202M
2nd Street
3rd Street
4th Street
Kitchen Road
Howe Road
Parade Field
Page 8
ATTACHMENT A – COST AND FOOD PLAN
COST AND FOOD OPTION
Course
Cost
Aircrew Survival
$40.00
What is included in the cost:
Aircrew Survival task guide, SAR Academy t-shirt, and SAR Academy Bracelet. The
student will be responsible for ALL meals and snacks.
MEALS NEEDED
Listed below are the meals that YOU are responsible to bring to the Academy:
Aircrew Survival 2 Breakfast, 3 Lunch, 2 Dinner for a total of 7 meals. ALL Meals and snacks
PLANNING YOUR MEALS
 MOST PEOPLE EAT MORE WHILE IN THE FIELD THAN THEY DO AT HOME, so please plan accordingly.
 Keep in mind, you will need to be able to cook at least one meal each day
 DO NOT BRING: Fresh foods, glass containers, JUNK FOOD, diet foods, etc.
 There is no electricity; therefore there are no refrigerators, stoves, microwaves, etc.
 The lighter the food package, the lighter your pack will be on the FTX. HOWEVER, you must also make sure you
eat enough calories each day.
 Each meal should be around 1,000 calories, for a total of 3,000 calories daily.
SUGGESTIONS FOR YOUR MEALS
Listed below are some suggestions for food:
Breakfast
 Instant oatmeal, dry cereal, breakfast bars, powdered milk, fruit juice, dried fruit, canned fruit, single-serving
applesauce, and peanut butter
Lunches/Dinners
 MREs, canned food (ravioli, spaghetti, stews, soups, vegetables, fruits), packaged tuna, ramen noodles, wheat
thins, summer sausage, etc.
Snacks/Others
 Trail mix, pop tarts (Not for breakfast) applesauce, teddy grahams, beef jerky, raisins, fruit cups, fruit roll ups,
peanut butter crackers, gushers, fiber bars, fruit snacks, fruit by the foot, granola bars, protein bars, oat and
honey bars, peanuts, nature valley bars, goldfish, nutria-grain bars, fig newtons, dried fruit, cereal, cereal bars,
cheese it crackers, sunflower seeds, mini oreos, mini nutter butter bars, chex mix, kudos bars, animal crackers,
beef sticks, combos, etc.
Page 9
MEAL MATRIX
So you’re getting ready to go out and buy all of this food, yet you’re not sure what you need or how much you need.
Probably you don’t even know what you are going to eat throughout the weekend! Well the SAR Academy Staff has a
helpful device that you can use to prepare and organize your meals for the week; we call it a Meal Matrix. A Meal Matrix
is an organized chart that states what you will be having for breakfast, lunch, and dinner. This matrix is very important
because it lists what you will be eating so you can make sure that you are eating properly and getting enough food
throughout the weekend! Scroll down to see an example of a Meal Matrix! This will give you a better idea of how to
create your own meal matrix!
SAMPLE MEAL MATRIX____
DAY
FRI
BREAKFAST
SAT
1 Package of cereal (in water)
Wheat Thins
Nutri-Grain Bar
1 Can of beef stew
Peanut butter crackers
Teddy grahams
SUN
LUNCH
1 package of tuna
1 package of dried fruit
Granola bars
1 Can of Ravioli
1 package of dried fruit
Trail Mix
1 pack of ramen noodles
2 cups of applesauce
Granola Bars
DINNER
1 pack of ramen noodles
1 can of fruit
1 protein bar
1 package of tuna
Veggie Straws
Fruit gushers
PACKING FOOD
 We highly recommended that food be packed in the following manner:
o Separate food into daily intake (breakfast, lunch, dinner, snacks)
o Use Zip Lock bags to store each meal/snack
 Label each meal with the following: Day 1-Breakfast, Day 1-Lunch, Day 1-Dinner, Day 1-Snacks
o Then take one day’s worth of food (breakfast, lunch, and dinner) and store it in a larger Zip Lock bag.
 Label the bag DAY 1. (this is NOT required, but HIGHLY suggested as rain, sand, bugs, etc., are
factors).
 DO NOT store food in cardboard boxes, or paper bags as they will not hold up under the rigors of the academy.
We highly suggest putting all of your food in a tote.
COOKING FOOD/PREPARATION
 All students must eat three meals a day, one MUST BE a HOT meal, prefer all three to be cooked. Some type of
heating device is required (see the packing list).
 We encourage students to eat as many snacks as they can, especially since they will be doing physical activity
each day
 MREs MUST be cooked in the heat pack and Ramen Noodles MUST be cooked in water!
 We strive for an average of 3,000 Calories daily
Page 10
ATTACHMENT B – TRAINING CHECKLIST / LINK PAGE




Meet the course specific requirements
o see page 5
Complete the required CAPF 31 with proper signatures-unit cc and parents
o see end of packet
Complete the required CAPF 160 and CAPF 161
o See end of the packet
Must be safety compliant
o www.capnhq.gov and sign into e-services
o Go to the left hand column and look for “Safety Management System”. Then find “online safety
education”. Choose one of the courses and take the quiz.
KEEP IN MIND, ALL REGISTERATION PACKETS ARE DUE TO LT COL PAM SAILE, 320 DOVER, WATERFORD, MI 48328 BY
1 JULY 2015. THAT MEANS ALL OF THE ABOVE ITEMS NEED TO BE COMPLETED BEFORE THEN OR EARLIER.
Page 11






ATTACHMENT C – STUDENT PACKING LIST
All Aircrew Survival Course students will be required to pack the following items.
If you plan on ordering items, we suggest using www.bepreparedtosurvive.com and www.bestglide.com. They
are an excellent source and have many items to choose from.
A gear inspection will be held during check-in. Make sure you have EVERYTHING on the packing list.
Students are also advised to leave any valuables at home, as there is no place to secure them for the week.
*Be sure to mark all clothing and equipment with your last name and CAP ID number*. Example: JOHNSON
113211.
Listed below is what we suggest for storage; however it is up to you on how you store your gear. Note: All of the
day gear must be carried in one pack and will be carried with you during the course.
What items to put into the storage device
Storage Device
Uniform items, personal hygiene items, food
Plastic Tote (Rubbermaid)
Field Gear
Hiking Pack, ALICE pack, bag, etc.
Day Gear
Back pack, Survival/Flight Vest, ALICE gear
ON PERSON AT ALL TIMES
The following items listed below will be on each student at all times:
Qty Item
1
1
1
1
1
Notepad (to take notes)and pencils/pens (placed inside a heavy duty zip lock bag)
Watch
ANSI Class II Reflective Vest (Orange, Lime Yellow, or Lime Green) (Vanguard $9.95)
Whistle (put with compass on the lanyard)
Orienteering Compass (plastic clear rectangular base plate, 2-degree markings, rotating dial)
Current CAP membership card, 101 card, First Aid/CPR card, etc.
Prescription Glasses (if you wear them) - Have a strap for them, too. Don't bring contacts. Spares if
possible.
Personal Medications- in pharmacy container w/name, dosage and physician (inhalers, bee sting kits)
UNIFORMS
These items should be stored in a Rubbermaid container or large duffel bag, neatly packed. Most items will stay at
mission base and/or supplement the 24 or 72 hour packs.
Qty Item
1
1
1
3
3
3
1
1
1
Nomex Flight Suit, insignia per CAPM 39-1 OR BDU Shirt and Pants, insignia per CAPM 39-1 (You may
bring both if you so choose too)
Combat boots, at least one pair, broken in before the Academy
Cover-CAP Baseball Cap (flight suit) or BDU Cover (BDUs) (NO BLACK HATS, Squadron hats, etc)
T-shirts (black)
Pairs of socks
Pairs of underclothing
Sweatshirt, Field Jacket, or Flight Jacket
Shower shoes or water shoes
Bathing suit (tasteful)
Page 12
PERSONAL HYGIENE KIT
Store bag in tote with uniforms and personal hygiene items.
Qty Item
1
1
Bag/pouch, which all of the items listed below should fit into:
Bath Towel and Wash Cloth
Soap, shampoo, toothbrush, toothpaste, foot powder, deodorant, shaving kit (as necessary) or feminine
hygiene items (as necessary) (3 day supply)
FOOD (SEPARATE FROM DAY GEAR)
All of your meals should be stored/brought in a Rubbermaid container or large duffel bag, neatly packed. A meal plan
can be found in Attachment A.
Qty Item
8
Meals (2 breakfast, 3 lunch,2 dinners)
Eating utensils (highly suggest bringing plastic…enough for each meal-i.e: 8 forks) However, you can bring
metal utensils. A wash bin with soap will be provided.
DAY GEAR/FLIGHT VEST
Note: If you currently have your own survival kit or vest, please bring it. Just make sure that if you don’t have the
items listed below, you include them in your kit/vest or bring them with you. You will be expected to carry your day
gear with you at all times. Make sure it is comfortable. This equipment does not have to be military style either. Most
of the items you already have around your house
Qty Item
1
1
1
50’
2
1
1
2
2 ea
1
2’
20’
1
2
1
Signal Mirror, small (Can use mirrored compass lid or CD if available)
Pocket or utility-type knife, multipurpose with can opener (Leatherman or Gerber, should be clean and
sharp)
Flashlight (with red or blue lens), with spare bulb and batteries
12 wooden waterproofed matches with a waterproof match container and striking surface
Nylon twine or small rope (Also known as parachute or 550 cord. Any color acceptable)
1 quart water containers (for drinking water) i.e. canteen, Gatorade bottle, hydration system. Each
student must have at least 2 quarts of water on them at all times.
Poncho or rain jacket/gear
Pair Leather Work Gloves
Chemical light stick (green)
Gallon and quart size Ziploc bag
Small First Aid Kit (Plus the following items: Quick Clot, safety pins, and ACE Bandage)
Aluminum Foil
Brass Snare Wire
Space Blanket/Emergency blanket
Large Plastic Garbage Bags
Duct tape, 5-10 feet (does not need to be a whole role. May be wrapped around a pencil)
FIELD GEAR (SEPARATE FROM THE DAY GEAR)
These items should be stored in a backpack minus your flight bag and camping chair.
Qty Item
1
1
1
1
Tent or shelter
Sleeping Bag (appropriate to climate) in a waterproof bag (heavy duty contractor bag works too)
Ground Cloth
Sierra cup, canteen cup, or mess kit
Page 13
1
1
1
Insect repellent with DEET, sunblock, lip balm (3 day supply)
Roll of Toilet Paper
Camping Chair
Please bring your flight bag that you currently use. This includes charts, headset, etc.
Sterno Stove (Suggest a portable, folding aluminum stove, and two 7-oz. cans of Sterno Gel fuel) Example:
http://www.cabelas.com/product/Camping/Camp-Cooking-Dining/Backpacking-Stoves%7C/pc/104795280/c/581015880/sc/104198580/SternoStove-Kit/1339362.uts?destination=%2Fcatalog%2Fbrowse%2Fbackpacking-stoves%2F_%2FN-1116228%2FNsCATEGORY_SEQ_104198580%3FWTz_l%3DSBC%253BMMcat104795280%253Bcat581015880&WTz_l=SBC%3BMMcat104795280%3Bcat581015880
%3Bcat104198580
Page 14
ATTACHMENT D – REGISTRATION CHECKLIST
Make sure you have the following completed:
 Meet the specific course requirements
 Pre-register for SAR Academy. Go to
https://docs.google.com/forms/d/1wypAevnHltjEOHjl5WLPU5o9lT8pQkqktwpB16C4hT0/viewform?c=0&w=1
 SENIORS: Complete Level I and the new Cadet Protection Basic Senior Course
 CADETS: Must be 18 years old
 Must have a current aircrew qualification
 Completed CAPF 31 with proper signatures (unit commander and parents)
 Include a check or money order for the cost of the course you attend made out to “Michigan Wing CAP”
 Completed CAPF 160 and CAPF 161
 Safety Complaint (at time of application and upon arrival to check-in)
 Have all items on the packing list
 Be sure you entered your t-shirt size on the CAPF 31
 Print this checklist
 Take the printed checklist, CAPF 31, CAPF 160, CAPF 161, your payment (check or money order), and put it all in
one envelope. Send it to the following address: LT COL PAM SAILE, 320 DOVER, WATERFORD, MI 48328
ALL COMPLETED REGISTRATION PACKETS ARE DUE TO
LT COL PAM SAILE, 320 DOVER, WATERFORD, MI 48328 BY 1 JULY 2015.
Page 15
APPLICATION FOR CAP ENCAMPMENT OR SPECIAL ACTIVITY
Name (Last, First, Middle Initial)
Member Type
Charter No. (e.g. GLR-MI-059)
Address (Include No., Street, City, State and Zip Code)
CAPID
CAP Grade
Grade in School
Religious Preference
Home Phone Number
Gender
Cell Phone Number
E-Mail Address
Date of Birth (mm/dd/yy)
Shirt Size
Title of Activity
Height (Inches)
Weight (Lbs)
Location of Activity
Hair Color
Eye Color
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 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
CAP FORM 31, OCT 13
Signature of Applicant
PREVIOUS EDITIONS WILL NOT BE USED
(Continued on reverse)
OPR/ROUTING: CP
Name (Last, First, Middle Initial)
Title of Activity
abc
RELEASE BY PARENTS OR GUARDIAN
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 Father’s Signature
Father or Legal Guardian
Witness for Mother’s Signature
Mother or Legal Guardian
Squadron Certification. (Squadron Commander’s signature is not necessary if the activity is approved in eServices or if it is
a squadron activity.)
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.
Date
Squadron Commander
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.)
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.)
Date
CAP FORM 31
Wing Commander (or designee)
REVERSE
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 make themselves
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)
Date of Birth
Height
Weight
Grade
CAPID
Charter Number
Hair Color
Eye Color
Gender
Allergies: List Names of Medication or Other Allergies (i.e., bee sting, food, plants) and types
of reactions; please note food allergy details with dietary restrictions below on back as well.
Do You Now Have Or Have You Ever Had Any Of The Following? Explain any yes’ in the
remarks section below or attach additional sheet. Conditions not specifically noted below
having the potential to interfere with performance during the special activity or encampment
should be documented in the remarks section.)
If “Yes” is marked in an item with multiple choices, please circle which problem applies.
No
Yes
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 activity
Heart Attack, chest pain, angina
Heart murmur, heart problems
Congestive heart failure
Irregular or rapid heartbeat
High or low blood pressure
Stomach trouble, ulcers
Hepatitis or liver problems
Diarrhea, constipation
Hernia or rupture
Kidney disease or stones
Prostate problems (men)
Frequent urination
Menstrual cramps (women)
Broken bone, joint problems
CAPF 160 JUN 13
Chronic or recurring injuries
Activity, mobility restrictions
Use of cane, walker, wheelchair
Back or neck pain or injury
Migraine or severe headaches
Dizziness or fainting spells
Head injury, unconsciousness
Epilepsy or seizure
Stroke, paralysis
Thyroid problems (low or high)
Diabetes, high or low blood sugars
Cancer, leukemia
Blood disease, hemophilia
Motion sickness
Special diet, food allergies
Current bedwetting problems
ADD (Attention Deficit Disorder)
Mental illness (bipolar, other)
Depression, anxiety, suicidal
Admission to the hospital
Other chronic medical illnesses
Sleep disorder, sleep apnea
Serious Injury
OPR/ROUTING: HS
Dietary Restrictions or Limitations (List any dietary restrictions like food allergies, diabetes,
gluten-free, vegetarian diets, etc.)
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.)
Date Tetanus
Booster
No Td or Tdap
Date:
Hepatitis Vaccine
No
Date:
Pneumonia
Vaccine
No
Date:
Varicella Immunization/chickenpox
No
Date:
Influenza Vaccine
No
Date:
Medication Information - Include supplements, over-the-counter medicines, herbals, creams,
etc., or write “None”.
Name of Medication/Inhaler
1.
Tablet
Strength
Times
taken
per day
Reason for
Medication
Any Special Dosing or Storage
Instructions (i.e., as needed, with
meals, must be refrigerated, etc.)
2.
3.
4.
Social History
Tobacco Use (packs per day, years
smoked, smokeless tobacco use)
Occupation (student or other)
Religious Preference
Remarks (Attach additional sheet if needed)
CONSENT FOR MINOR CADET PARTICIPATION, MEDICATIONS, TREATMENT
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 prescription
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 if permission is denied).
In case of emergency, I understand 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
CAP Form 160
________________________________________________________________________________________________________
SIGNATURE OF PARENT/GUARDIAN
Reverse
EMERGENCY INFORMATION
(Insurance/Physician Information, Emergency Contacts, Minor Consents
Name (Last, First, Middle)
Grade
CAPID
Mailing Address (Number and Street)
City
(Area Code) Home Phone
(Area Code) Cell Phone
Charter Number
State
Zip Code
Primary Insurance Information (Please attach copy of insurance cards, front and back)
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
(Area Code) Phone
Mailing Address (Number and Street)
City
State
Zip Code
Emergency Contact (Parent, guardian or closest relative to be notified in case of emergency)
Name
Relationship to Applicant
Mailing Address (Number and Street)
City
State
(Area Code) Pager
(Area Code) Day Phone
(Area Code) Night Phone
(Area Code) Cell/Mobile Phone
Zip Code
Unit Commander Name and Grade
Unit Name
(Area Code) Unit Commander Day Phone
(Area Code) Unit Commander Night Phone
CAPF 161, JUN 13
OPR/ROUTING: HS