Fillable Printable Summer Camp Nomination / Registration Form - US Air Force Youth Programs

Summer Camp Nomination / Registration Form - US Air Force Youth Programs

Page 1 of 4

US Air Force Youth Programs

Summer Camp Nomination / Registration Form

Privacy Act of 1974

Authority: Title 10, United States Code, Section 8013

Principal Purposes: To obtain youth and family program eligibility and background information for proper

assignment of the individual into activities and workshops; to contact participant’s parents/guardians in the event of

an accident or illness; obtain sponsor consent for access to emergency medical care.

Routine Uses: To provide information to medical personnel in the absence of a parent; to notify the parents in case

of emergency, to contact the youth’s parent’s/guardian relative to the youth’s participation in programs.

Disclosure: Disclosure of requested information is mandatory.

*This applies to all pages in the Air Force Youth Programs Camp registration package.

Camp Choice: 2

Camp Choice: 3

Camp Choice:

LIVE GREEN: Applications must be submitted in original digital format and digitally signed.

PARTICIPANT INFO

First Name:

Last Name:

Male:

Female:

Age as 31 May:

Installation:

MAJCOM:

Adult Shirt Size:

Grade this Fall:

Cumulative GPA:

Sponsor’s Status (Check One):

AD assigned to AF / AF-led JB

Retired Air Force DOD Civilian (APF/NAF)

Air Force Reserve Air National Guard

Parent E-Mail Address for all correspondence:

Has your sponsor been deployed

within the last 6 months?:

Parent/Guardian Information

Additional Emergency Contact

Sponsor

Name

Contact #:

Parent/Guardian

Name:

Contact #

Contact Name/Relation:

Phone #:

MEDICAL

I hereby authorize my child to receive emergency medical treatment whenever it is deemed necessary at any U.S.

Military Facility or any other medical facility when a U.S. Military Medical Facility is not available.

Health Insurance:

Policy Number:

1. List any medical conditions, allergies, and medications which may require camp staff awareness. All

medications must be prescribed by a physician and have written directions for administration (number of times

per day, amount of medication to be administered). Provide the instructions below to supplement those

indicated on the prescription bottle. Indicate any medications which require special storage:

2. List special dietary or physical accommodation requirements:

Additional Notes:

I understand and to the best of my knowledge all of the information stated herein this document is true and

accurate.

_______________________________

Signature of Parent/Guardian

Page 2 of 4

US Air Force Youth Programs

Summer Camp Nomination / Registration Form

WAIVER

In consideration of my child’s participation, I hereby release and hold harmless the Armed Services and/or any

of their employees, instructors or agents, from any and all present and future claims, actions, or suits, for any

property damage, personal injury, or wrongful death, arising as a result of my child engaging in any Air Force Youth

Programs Camp activities or any activities incidental thereto, whatever, whenever, or however the same may occur. I

also hereby voluntarily waive the right to pursue any and all such claims, actions, or suits that may be made by

me, my family, estate, heirs, or assigns.

I am expressly aware that the Air Force Youth Programs camps’ schedule of events will include classroom

activities, instruction, tours, recreational programs, group outings and some potentially high risk outdoor

experiences. Inherent in these activities is the possibility of certain physical risk that can cause injury. I understand

that participation will require travel to and from the program site. I also understand that the program will require

travel to and from the various locations within the area. My child is voluntarily participating in this activity with

knowledge of the potential risk and potential injury involved and I hereby agree to accept any and all inherent risk of

property damage, personal injury, or death.

I understand that this waiver is intended to be as broad and inclusive as permitted and agree that if any portion is

held invalid, the remainder of the waiver will continue in full legal force and effect.

I have read this form and fully understand that by signing this form, I am giving up legal rights and/or remedies

which may be available to me against the United States Armed Forces, its employees, instructors and agents.

I understand and to the best of my knowledge all of the information stated herein this document is true and

accurate.

______________________________ _______________________________

Name of Participant (please print) Signature of Parent/Guardian

YOUTH CODE of ETHICS (must be reviewed/understood with youth/teen applicant)

 I will be courteous and respectful towards others and I agree to value and respect others’ ideas.

 I will attend and actively participate in all sessions and activities during the program.

 I will conduct myself in a professional manner at all times.

 I will not use alcohol, tobacco, or drugs as I will be a role model and represent my installation and AF.

 I will follow guidance provided by all Air Force Youth Development staff.

 I understand that if I am required to return home because of misbehavior that any additional airfare cost incurred

will be the responsibility of myself and my parents.

My child and I understand and hereby agree to abide by the above Code of Ethics.

I consent to print / online publication; use of photographs and video; and information contained in this

application form by the USAF.

Signature of Parent/Guardian:

VERIFICATION of ELIGIBILITY

YP Directors, designees or Guard/ Reserve Representatives can serve as Verification Officials. Please conduct a

final verification of the youth/teen’s eligibility for participation in AF Youth Program Camps. For verifying

eligibility it is recommended to use the ID card.

I have confirmed that this youth is eligible through his/her affiliation with the Air Force.

________________________________ ___________________ ________________________________

Name /Position of Verification Official Phone # Signature of Verification Official

Page 3 of 4

US Air Force Youth Programs

Summer Camp Nomination / Registration Form

Name: Installation:

RESUME & ESSAYS Please do not include any certificates and or additional attachments.

School Sponsored Extracurricular and Leadership Activities:

Please indicate the school-sponsored extracurricular activities and leadership position(s) that you have actively

participated in or held during the past 12 months (include dates, achievements/awards earned, participation hours):

Non-School Sponsored Extracurricular and Leadership Activities:

Please indicate the activities and leadership position(s) that you have actively participated in or held outside of

school (e.g., sport teams, clubs, youth programs, scouts, church) during the past 12 months (include dates,

achievements/awards earned, participation hours):

Honors/Awards (last two years):

Please list honors/awards/scholarships (e.g., Eagle Scout, Gold Award, Church, School) and the year/s you received

the aforementioned honor:

Community Service Projects (last two years):

Please list any community service projects and hours in which you have actively participated:

Aviation Camp Essays - Complete this section if you are applying for Aviation Camp

Essay 1: What specific attribute, quality, or skill distinguishes you from everyone else? How did you develop this

attribute?

Essay 2: The US SecDef called the F-35 Lightning II ‘the last manned fighter.’ What is the future for the AF?

Page 4 of 4

US Air Force Youth Programs

Summer Camp Nomination / Registration Form

Name: Installation:

RESUME & ESSAYS Please do not include any certificates and or additional attachments.

Teen Leadership Camp Essays - Complete this section if you are applying for Teen Leadership Camp

Essay 1: Outline your vision, goals and aspirations for future endeavors.

Essay 2: Describe a situation you experienced in which you showed exceptional leadership to overcome a problem or

dilemma.

Space Camp Essays - Complete this section if you are applying for Space Camp

Essay 1: What do you hope to learn from this camp? How do you plan to use that knowledge?

Essay 2: Why is space exploration important? As the first human on Mars what would you accomplish?