Cap Form 15 - Application For Cadet Membership In The Civil Air Patrol Page 2
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1
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3To help us better serve our members, please tell us how you heard about Civil Air Patrol (check all that apply):
Air Show
CAP Exhibit
CAP Member
School
Friend
Radio
Magazine
Television
Family Member
CAP Website
CAP Volunteer Magazine
Other (please name):
Voluntary Statistical Information (For Demographic Research Only -- Not Required For Membership)
Identification:
White
Afro-American
Hispanic
Asian
Pacific Islander
American Indian
Alaskan Native
A NOTE TO THE NEW CADET
Congratulations on joining Civil Air Patrol! To fly in CAP aircraft and be credited for achievements in the Cadet Program, your
application must be processed by CAP National Headquarters. So please rush this application and your check for dues to:
NATIONAL HEADQUARTERS CAP/PMM
105 S. HANSELL ST.
MAXWELL AFB AL 36112
HEALTH CERTIFICATE
PARENT’S EVALUATION
The activities in which your child will participate while a member of CAP are generally comparable to those experienced in high
school, including physical education activities. To assure the fullest degree of pleasure and success in Civil Air Patrol, the cadet
should be healthy, both physically and mentally. If you mark “NO” in all the boxes below, your cadet will be placed in a Physical
Fitness Category I, and will not require a physical examination. If you mark “YES” in any box, an examination by a physician is
required.
YES NO
YES
NO
SUGAR OR ALBUMIN IN URINE
FREQUENT OR SEVERE HEADACHES
EPILEPSY
DIZZINESS OR FAINTING SPELLS
MENTAL OR NERVOUS DISORDER
UNCONSCIOUSNESS FOR ANY REASON
DRUG OR NARCOTIC HABIT
EYE TROUBLE (not correctable with glasses)
EXCESSIVE DRINKING HABIT
HEART TROUBLE
REJECTION FOR LIFE INSURANCE
CHRONIC OR RECENT EAR TROUBLE
ASTHMA
HIGH OR LOW BLOOD PRESSURE
ALLERGIES
SIGNIFICANT ABDOMINAL TROUBLE
OTHER LIMITATIONS
(INCLUDING HERNIA) UNLESS
CORRECTED
I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE HEALTH OF THE APPLICANT IS AS SHOWN
ABOVE.
Parent or Legal Guardian Signature
Date
PHYSICIAN’S CERTIFICATE
(Required if “YES” was marked in any box above)
I certify that I have examined the applicant whose name appears hereon and that he/she does not possess physical limitations that
would preclude participation in Civil Air Patrol as explained in the above parent’s evaluation.
UNRESTRICTED: Physically capable of full participation.
TEMPORARILY RESTRICTED: Medical condition or injury is temporary in nature.
PARTIALLY RESTRICTED: Indefinitely or permanently restricted from a portion of the program.
PERMANENTLY RESTRICTED: Medical condition or injury is chronic or permanent in nature and individual is restricted
from all Civil Air Patrol physical activities.
Physician’s Address
Physician’s Signature
Date
Physician’s Phone
CAP FORM 15, FEB 14 REVERSE
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