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191 RCACS Adventure Training Department
Application for Course
*Return this form to the Training Office before the Course
Course Name: Operation Hocus Pocus
Serial Number:1015
A. Personal Information
Rank
Last Name
Level
Age
First Name ________________
Male/Female
Birthdate ___ _______________
(Day/Month/Year)
Man. Medical #:
Phone Number: ____________ _________
( 9 Digit Number)
Address:
(Emergency 24 hr Contact)
City:
Postal Code: ________
Last Adventure Training Course Attended:
Date:________
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B. Experience
Have you attended a previous survival weekend?
Y N
Have you attended a survival exercise at a Summer Training Centre?
Y N
Have you completed the course 1) Aircrew Survival
Y N if yes, What year?
2) Survival Instructor
Y N if yes, What year?
Do you have survival experience outside of what was mentioned above? Y N
(if yes, briefly describe it.)
Do you have CURRENT first aid training? Y N
if yes, List type.
C. Medical History
1. Do you require medication?
If Yes, what kind and what does it treat?
2. Do you have any allergies and/or food restrictions (ie. Vegetarian) ?
If Yes, what are you allergic to/ restricted from and how severe is your reaction ?
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D. Transportation
You are responsible for your own transportation to and from the squadron headquarters. The times
of arrival and dismissal will be listed in the Course Joining Instructions. How will you be getting home at
the end of the course? (Check One)
Phone # _____________
Name:
Phone #_____________
Name:____________________ Phone #______________
E. Legal/Medical Consent
I
grant permission for my son/daughter/ward to attend
this training course. I understand that this form is only an application and not a guarantee
of attendance. I authorize the directing staff to act in place at a medical facility in the
event my son/daughter/ward is injured or requires urgent medical attention. The directing
staff will ensure my son/daughter/ward receives proper medical attention and will advise
me as soon as possible.
Signature of Parent/Guardian_________________________________Date_____________________________
For Official Use Only
Date Received:
Comments:
Approved: Yes
No
Requires Waiver from C.O.
Authorization:
Effective 20 Oct 2015
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Medical Requirements
The Survival Training Department ensures that every Cadet receives proper medical attention
when required, no matter how big or small. We are asking that if your cadet has any medical
condition, temporary, past or otherwise, to let us know in a written form (below), describing in-depth
what it is, what you need to take for it, what we should do if something happens, etc.
This form must be returned (medical condition or not) before the day of departure. Give this
document, completed, directly to the Survival Training Officer. These documents will be kept
confidential to the staff alone.
Parent's Signature- I____________________________ have completed this form with my cadet
and ensured it is filled out correctly and nothing is left out concerning my child's Health.
Cadet Signature- I________________ understand that if, at any time during the exercise, I require
medical attention I will inform my supervisor immediately.
MEDICAL CONDITION(s) (If none strikethrough the area below and sign)
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