YOUTH SPECIALTY CAMPS NOTE: Applications must be submitted electronically to the Youth Programs Director, lisa.laconte@us.af.mil, by 28 March 2014. All lodging, meals, and program costs will be funded at no cost to the participant. Airfare, however, is the responsibility of the attendee, but financial concerns can be discussed with the Youth Programs Director. Teen Aviation Camp! What: The intent of the program and scheduled tours are designed to give all attendees an experience that will help them determine if aviation or the Air Force Academy is a career choice. Date/Location: The Air Force Teen Aviation Camp will be held 7-12 Jun at the Air Force Academy in Colorado Springs, CO. Colorado Springs is located approximately 60 miles south of Denver and approximately 30 miles north of the Colorado Springs International Airport. assigned to or living on an AF/JB installation, AF Retired Military, AF Civilian Employees, Air National Guard or AF Reserve who have been activated within the last 12 months Youth entering their Sophomore or Junior year in the Fall of 2014 Note: Previous Teen Aviation Camp attendee may not apply AF Space Camp! What: Air Force Space Camp is hosted by the US Space and Rocket Center. While at camp, youth will experience, imagine, and interact through Space Shuttle mission simulations and tours of the center. The camp is an inspiring week of fun and enriching space activities. More info is available at www.spacecamp.com Date/Location: Space Camp will be held 27 Jul-1 Aug at the US Space and Rocket Center, Huntsville AL. assigned to or living on an AF/ JB installation, AF Retired Military, AF Civilian Employees, Air National Guard or AF Reserve who have been activated within the last 12 months Must have a minimum GPA of 2.8 (must provide documentation) Must be ages 12-14 to attend Space Academy or Robotics Academy, which is an intense experience designed to immerse middle school students in the science and technology of the space program. Must be ages 15-18 to attend Advanced Space Academy or Aviation Challenge. This tract will immerse teens in science, technology, engineering and math. AF Teen Leadership Camp! What: The Air Force Teen Leadership Camp is a 5-day residential program which provides youth a glimpse of what university life is like while developing their leadership skills. Activities include team building, High/Low ropes course, conflict resolution, public speaking, and more. Date/Location: The Air Force Teen Leadership Camp will be held 9-13 Jul at the University of Texas at San Antonio. assigned to or living on an AF/ JB installation, AF Retired Military, AF Civilian Employees, Air National Guard or AF Reserve who have been activated within the last 12 months High school students who ve completed their freshmen year prior to the camp and are interested in developing leadership skills For more information, please call Lisa LaConte at 828-7956 Fill out digital Nomination Registration Form, sign electronically, and email to lisa.laconte@us.af.mil
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. 1 st Camp Choice: 2 nd Camp Choice: 3 rd Camp Choice: LIVE GREEN: Applications must be submitted in original digital format and digitally signed. PARTICIPANT INFO First Last Male: Female: Age as 31 May: Installation: MAJCOM: Adult Shirt Size: Grade this Fall: Cumulative GPA: Sponsor s Status (Check One): Parent E-Mail Address for all correspondence: Has your sponsor been deployed within the last 6 months?: Parent/Guardian Information Sponsor Name Contact #: MEDICAL Parent/Guardian Contact # AD assigned to AF / AF-led JB Retired Air Force DOD Civilian (APF/NAF) Air Force Reserve Air National Guard Additional Emergency Contact Contact Name/Relation: Phone #: 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 1 of 4
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 2 of 4
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 3 of 4
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? Page 4 of 4