Parachuting center adult registration forms and medical statements (photographed set)
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Original title: Elsinore Parachuting Center adult registration forms and medical statements (photographed set)
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Id: Cooper-Part-64:396-403
Subject: Cooper Files: Cooper-Part-64:396-403 Document: Parachuting center adult registration forms and medical statements (photographed set) Id: Cooper-Part-64:396-403 Page: https://cooper.theunsolved.net/documents/Cooper-Part-64%3A396-403 What is wrong (title, date, type, which pages belong together, copies)? What does the scan show?
A person reads every report. Corrections are made by hand, to the data — titles, dates, names, which pages belong together — never to the scans, and they can take a while to appear.
FBI 164-81, Vault Part 64 pp. 396–403 (DB Cooper-26846–26853), Form — cooper.theunsolved.net/documents/Cooper-Part-64%3A396-403
PARACHUTING CENTER
ADULT REGISTRATION FORM
(Check Only One Please)
High School: [illegible] Attending [illegible] Did Not Complete X Graduated
College: Please give name of: 1. Attending 2. Attended 3. Graduated
Other
How did you learn of the center? (Check Only One Please) [] "A Sport Is Born" Movie [] Magazine Article [] Sports Show (Which) ____ [] Yellow Pages Ad [] World Championship 1962 [] Friend (Name) ____ [] Word of Mouth [] Lecture Other ____
(CALIF[ornia] ____) Name: [illegible] Address: [illegible] Date of Birth: [illegible] Occupation: [illegible] City: [illegible] State: [illegible] Zip Code: [illegible] Phone: [illegible] Present Interests: [illegible]
HOW DID YOU TRAVEL TO CENTER? [] Phone [illegible] Car [illegible] Bus [] Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not aware of and am not under treatment for any physical infirmity or chronic ail- ment, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been treated for any of the following:
1.) Corr[ect] or pulmonary condition or disease 5.) Nervous disorder 2.) Fainting or low blood pressure 6.) Diabetes 3.) [illegible] spells or convulsions 7.) Kidney or related diseases 4.) Kind of hearing
Signature: [illegible] Date: [illegible]
TURN FORM OVER -- READ AND COMPLETE OTHER SIDE
---
PARACHUTING CENTER
ADULT REGISTRATION FORM
(Check Only One Please)
High School: [illegible] Attending [illegible] Did Not Complete [] Graduated
College: Please give name of: 1. Attending 2. Attended 3. Graduated
Other
How did you learn of the center? (Check Only One Please) [] "A Sport Is Born" Movie [] Magazine Article [] Sports Show (Which) ____ [] Yellow Pages Ad [] World Championship 1962 [] Friend (Name) ____ [] Word of Mouth [] Lecture Other ____
Name: [illegible] Angelet Address: [illegible] City: [illegible] State: [illegible] Zip Code: [illegible] Date of Birth: [illegible] Present Interests: [illegible] Phone: [illegible]
HOW DID YOU TRAVEL TO CENTER? [] Phone [] Car [] Bus [] Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not aware of and am not under treatment for any physical infirmity or chronic ail- ment, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been treated for any of the following:
1.) Cardiac or pulmonary condition or disease 5.) Nervous disorder 2.) Fainting or low blood pressure 6.) Diabetes 3.) [illegible] spells or convulsions 7.) Kidney or related diseases 4.) Kind of hearing
Signature: [illegible] Date: [illegible]
TURN FORM OVER -- READ AND COMPLETE OTHER SIDE [illegible] -- [illegible] READING AND EATING THIS SIDE -- TURN FORM OVER -- READ AND COMPLETE O[THER SIDE] [illegible text at bottom]
---
DB Cooper-26846
---
b6 b7C
ADULT [redacted] REGISTRATION FORM
Check Only One Please) High School [redacted] Attending Did Not Complete Graduated
College, if one give name of: Attending Attended Graduated
Other:
HOW DID YOU TRAVEL TO CENTER? [redacted] Bus [checkbox] Other
How did you learn of [the] center? (Check Only One Please) [checkbox] "A Sport is Born" Movie [checkbox] Magazine Article [checkbox] Sports Show [Which] [checkbox] Yellow Pages Ad [checkbox] World Championship 1962 [checkbox] Friend (Name) [checkbox] Word of Mouth [checkbox] Lecture
Other:
b6 b7C
[redacted personal information fields including name, address, city, state, zip code, phone]
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not a victim of any physical infirmity or chronic ail- ment, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been under [medical] for any of the following:
1.) Cardiac or pulmonary condition or disease 2.) [illegible] or [illegible] paralysis 3.) Fainting spells or convulsions 4.) [Loss] of hearing
5.) Nervous disorder 6.) Diabetes 7.) Kidney or related diseases
Date: 9/14/71
---
PARACHUTING CENTER
ADULT REGISTRATION FORM
(Check Only One Please) High School Attending Did Not Complete Graduated
College: Please give name of: Attending X Attended Graduated
Other:
HOW DID YOU TRAVEL TO CENTER? [checkbox] Plane X Car [checkbox] Bus [checkbox] Other
How did you learn of [the] center? (Check Only One Please) [checkbox] "A Sport is Born" Movie [checkbox] Magazine Article [checkbox] Sports Show (Which) [checkbox] Yellow Pages Ad [checkbox] World Championship [illegible] X Friend (Name) [checkbox] Word of Mouth [checkbox] Lecture
Other:
b6 b7C
[redacted personal information]
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not a victim of and am not under treatment for any physical infirmity or chronic ail- ment, or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been under [medical] for any of the following:
1.) Cardiac or pulmonary condition or disease 2.) [illegible] or [illegible] paralysis 3.) Fainting spells or convulsions 4.) [Loss] of hearing
5.) Nervous disorder 6.) Diabetes 7.) Kidney or related diseases
Date: 9/14/71
I HAVE READ A [illegible] PERTAINING AND JUMPING THIS SIDE -- TURN FORM OVER -- READ AND SIGN OTHER SIDE [illegible additional instruction text]
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DB Cooper-26847
[illegible] ... [redacted] ... D [guess: Bank] [redacted] [illegible] County, C [illegible] [illegible] [illegible] -N7 [illegible] [illegible] ... [illegible] [guess: pickup] [guess: from] [illegible] b6 b7C
---
PARACHUTING GENERAL
ABOUT [illegible] MODIFICATION FORM
Can [I/We] [guess: Copy One Please] How did you [guess: learn] [illegible] [illegible] ... [illegible] [guess: about] [guess: Our] C[illegible] [illegible] no [illegible] [ ] "A Sport to [guess: Come]" [illegible] [illegible] [guess: at] [guess: Company] [illegible] [ ] Newspaper or [illegible] [illegible] [illegible] [ ] [guess: Window] [guess: Display] [illegible] [ ] [guess: Yellow] P[guess: ages] [illegible] Can you [illegible] [guess: give] name of[s] [ ] Radio/[guess: TV] [illegible] [guess: or] [illegible] [illegible] [ ] Printed Material [illegible] [illegible] [guess: Suggested] [illegible] [ ] Word of Mouth O[illegible] [redacted] [guess: Date] [illegible]
HOW DID YOU TRAVEL TO CENTER? [ ] Plane [ ] Car [ ] Bus [ ] Other
---
INSTRUCTIONS REGARDING PARACHUTE TRAINING AND JUMPING
[illegible] ... [illegible] if [illegible] [guess: under] [illegible] [guess: years], it [guess: has] any physical infirmity or chronic ail- [illegible] [guess: that] [guess: I/had] [guess: neither] [guess: Visual] or [guess: have] corrective lenses, and that I [guess: have] [illegible] ... of:
[illegible] [guess: at] [illegible] [guess: 5.] Nervous disorder [illegible] [illegible] 6.) [guess: D]iabet[guess: es] 7.) [guess: K]idney or related diseases
Date [guess: 2]-[guess: 72] -7[guess: 1]
[illegible] [guess: No.] [illegible] [guess: and] [illegible] -- [guess: 20],[guess: 18] [illegible] and Or[illegible] -- READ AND [guess: COMMAND] OF [illegible]
---
DB Cooper-26848
PARACHUTING [CENTER] [illegible] FORM
ADULT REGISTRATION FORM
[Fields, mostly illegible:] Last Name . . . First . . . MI Date . . . [Ca] . . . Age . . . [illegible] Sex . . . [illegible] . . . City . . .
Have you been of the center? [illegible] Gray [Comp R.] A [illegible] [illegible] Mother [illegible] [illegible] [Julianne] [illegible] Show Within [illegible] Finger Ad b6 [illegible] Championship 1962 b7C [illegible] Fingers [illegible] Word of Mouth [illegible] Other
HOW DID YOU TRAVEL TO CENTER? Car . . . Bus . . . Other
MEDICAL STATEMENT: [I am a] [illegible] UNDERGOING PARACHUTE TRAINING AND JUMPING [I hereby] [certify] [that I] [am] [in] [good health] [and] [not] [under] [treatment] for any physical infirmity or chronic ail- [ment], or [illegible] of any [nature], and that I have normal vision or have corrective lenses, and that I have [no] [illegible] [for] [illegible] [illegible] [of] [this] [undertaking]:
[Conditions or additional] [illegible] [order] [or] [illegible]: 5. Nervous disorder 6. Diabetes 7. [Kidney] or related diseases [illegible] [of] [illegible]
---
PARACHUTING CENTER
ADULT REGISTRATION FORM
[Fields, mostly illegible:] [illegible] . . . [illegible] [Ca] [illegible]
Have you [been] of [the center]? [illegible] [City] [Comp R.] A [illegible] [illegible] [illegible] [illegible] [illegible] Article [illegible] [Shows] [Show] [illegible] b6 [Yellow] Pages [Ad] b7C [illegible] [Comp] [onion] [Friends] Name- [Word] of Mouth [illegible] Other
HOW DID YOU TRAVEL TO CENTER? Car . . . Bus . . . Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING [I hereby] [certify] [that I am] [in] [good] [health] [and] [not] [under] [treatment] for any physical infirmity or chronic ail- [ment], or [illegible] of any [nature], and that I have normal vision or have corrective lenses, and that I have [no] [illegible] [for any] [of] [this] [undertaking]:
[Conditions or [illegible] [or] [illegible]: 5a. Nervous disorder 6. Diabetes 7. [Kidney] or related diseases
[illegible]
Date . . . [illegible]
[NOTE:] [illegible] [illegible] [illegible] [DATING] THIS SIDE -- TURN FORM OVER -- READ AND COMP[LETE]
---
DB Cooper-26849
PARACHUTING CENTER ADULT REGISTRATION FORM
[redacted] n [illegible] Check Only One: Please) How did you [learn]: Check Only [One]
High School _ Attending _ Did Not Complete _ Graduation
College, Please give name of: _ Attending _ [Finished] _ Graduated
Other:
HOW DID YOU TRAVEL TO CENTER? [illegible] Train, S-Car [illegible], Bus, [illegible] Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I [illegible] certify that I am not under a doctor's treatment for any physical infirmity or chronic ail- [ment] [illegible] that I have [not] had [illegible] normal vision or have corrective lenses, and that I have [illegible] my [illegible] knowledge:
1. [illegible] disorder 2. Diabetes 3. [Fainting] or [related] [diseases]
[Signature block - redacted]
DATE: [redacted] OVER [illegible] READ AND COMPLETE [illegible]
---
PARACHUTING CENTER ADULT REGISTRATION FORM
[redacted] Check Only One Please) How did you [learn]: (Check Only One)
High School: _ Attending _ Did Not Complete _ Graduation
College, please give name of: _ Attending _ Attended _ Graduated
Other:
How did you [learn]: Check Only One _ "A Sport is Born" _ Magazine Article _ Sports Show [illegible] _ Yellow Pages Ad _ World Champions _ Friend (Name) _ Word of Mouth _ Lecture _ Other
HOW DID YOU TRAVEL TO CENTER? Plane [illegible] Car [illegible] Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not under a doctor's treatment for any physical infirmity or chronic ail- ment, or [member] of any [illegible] normal vision or have corrective lenses, and that I have [illegible] to [the best] of my [illegible] knowledge, [illegible] [illegible] that I have
1. Chronic or pronounced [illegible] condition 2. [heart] or [illegible] condition or [illegible] 3. [illegible] [significant] or [illegible] 4. [illegible] of [relevant] [illegible]
[Signature block - redacted]
DATE: [redacted] NOTATION -- AFTER READING, SIGN AND RETURN BACK. THIS [illegible] FORM OVER READ AND COMPLETE. [illegible]
---
DB Cooper-26850
---
b6 b7C
[REDACTED] ADULT REGISTRATION FORM
Permission: [illegible] Address: [REDACTED]
Name: [REDACTED] CAUC[asian] 2 a [illegible] [REDACTED] Age: Weight: Height: Occupation: [REDACTED] Date of Birth: [REDACTED] Sex: [REDACTED] Present Address: [REDACTED] City: State: Zip Code: Phone: [REDACTED]
Check Only One Please: High School Attending D id Not Complete College, Master, over [illegible] of Attending Advanced Graduating
Other: [REDACTED]
How did you learn of this c[enter]? (Check Only One Please) A Sport Is Born" Movie Magazine Article Sports Snow (Which) Yellow Pages Ad World Championship 1962 Friend (Name) Word of Mouth [illegible]
HOW DID YOU TRAVEL TO CENTER? Car Bus Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am in good health and not under the care or order of any doctor for any physical infirmity or chronic ail- ment, or other of any [illegible] that [illegible] or have corrective lenses, and that I have never been refused [illegible] for any of the following:
1. Cardiac or [illegible] condition or [illegible] 5. Nervous disorder 2. [illegible] or [illegible] condition 6. Diabetes 3. Fainting [illegible] or [illegible] 7. Kidney or related diseases 4. [illegible] of [illegible]
[Signature block REDACTED]
IMPORTANT -- AFTER READING, SIGNING AND DATING THIS SIDE TURN FORM OVER -- READ AND COMPLETE OTHER SIDE
---
PARACHUTING CENTER ADULT REGISTRATION FORM
[Same form fields as upper copy, largely REDACTED]
Name: [REDACTED] CAUC[asian] [REDACTED] Phone: [REDACTED] Occupation: [REDACTED] Date of Birth: [REDACTED] Present Address: [REDACTED] City: [REDACTED] State: [REDACTED] Zip: [REDACTED]
Check Only One Please: High School Attending D id Not Complete College, Master, [illegible] Attending Graduated
How did you learn of this center? (Check Only One Please) A Sport Is Born" Movie Magazine Article Sports Snow (Which) Yellow Pages Ad World Championship 1962 Friend (Name) Word of Mouth Lecture
Other:
HOW DID YOU TRAVEL TO CENTER? Car Bus Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am in good health and not under the care or order of any doctor for any physical infirmity or chronic ail- ment, or other of any [illegible] and have corrective lenses, and that I have never [illegible] for [illegible]:
1. Cardiac or [illegible] condition or eliminate 5. Nervous disorder 2. [illegible] 6. Diabetes 3. Fainting [illegible] 7. Kidney or related diseases 4. [illegible]
[Signature block REDACTED]
IMPORTANT -- AFTER READING, SIGNING AND DATING THIS SIDE TURN FORM OVER -- READ AND COMPLETE OTHER SIDE
---
DB Cooper-26851
---
b6 b7C
ADULT REGISTRATION FORM
[Fields visible but mostly illegible due to copy quality]
Name: [illegible] N.Y. City: [illegible] Occupation: [illegible] Date of Birth: [illegible] Present Address: [illegible] City: [illegible] State: [illegible] Phone: [illegible]
(Check Only One Please) Male / Female Height: [illegible] Weight: [illegible]
How did you learn of this center? (Check Only One Please) [ ] "A Sport Is Born" Movie [ ] Magazine Article [ ] Sports Show (Which) [ ] Yellow Pages Ad [ ] World Championship 1962 [ ] Friend (Name) [ ] Word of Mouth [ ] Lecture [ ] Other
HOW DID YOU TRAVEL TO CENTER? [ ] Train [ ] Car [ ] Bus [ ] Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not under a doctor's care nor under treatment for any physical infirmity or chronic ailment, or if any of my [illegible] not [illegible] normal vision or have corrective lenses, and that I have [illegible]
1. Cardiac or pulmonary malfunction or disease 2. High or low blood [guess: pressure] 3. Fainting spells or convulsive seizures 4. [illegible]
5. Nervous disorder 6. Diabetes 7. Kidney or related diseases
Date: [illegible]
TURN FORM OVER READ AND COMPLETE OTH[ER SIDE]
---
PARACHUTING CENTER ADULT REGISTRATION FORM
[Second copy of the same form, largely identical content]
Check Only One Please: [ ] A Sport Is Born Movie [ ] Magazine Article [ ] Sports Show (Which) [ ] Yellow Pages Ad [ ] World Championship 1962 [ ] Friend (Name) [ ] Word of Mouth [ ] Lecture [ ] Other
How did you learn of this center?
HOW DID YOU TRAVEL TO CENTER? [ ] Car [ ] Bus [ ] Other
MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not under a doctor's care nor under treatment for any physical infirmity or chronic ailment, or if any of [illegible] this [illegible] normal vision or have corrective lenses, and that I have [illegible]
1. Cardiac or [guess: pulmonary] malfunction or disease 2. High or low blood [guess: pressure] 3. Fainting spells or convulsive seizures 4. [illegible]
5. Nervous disorder 6. Diabetes 7. Kidney or related diseases
Date: [illegible]
IMPORTANT -- AFTER READING, SIGNING AND DATING THIS .05F -- TURN FORM OVER -- READ AND COMPLETE OTHER SIDE
---
DB Cooper-26852
---
b6 b7C
[Last Name] _____ [First Name] _____ [Middle Initial] _____
ADULT REGISTRATION FORM .Check Only One Pleas[e]
City _____ State/[Code] _____ Zip Code _____ High School Photo _____ Age _____ Weight /5[0] [illegible] [illegible] 1) Attending 2) Did Not Complete Occupation _____ 3) Graduated Date of Birth _____ Sex M College: Please give name of: Present Address [illegible handwriting] 1) Attending 2) Entered City _____ State _____ Zip Co[de] 3) [Graduated] Phone _____ Other
How did you learn of this course? (Check Only One Please) 1) "A Sport is Born" Movie 2) Magazine Article 3) Sports Show (Which) 4) Yellow Pages Ad 5) World Champ[ionship] 6) Friend (Name) _____ 7) Word of Mouth 8) Lecture Other
HOW DID YOU TRAVEL TO CENTER? b[us] X C[ar] [illegible] Other
---
MEDICAL STATEMENT FOR UNCONDITIONAL PARACHUTE TRAINING AND JUMPING
I hereby certify that I am not [under] the [care] of [a] [physician] or [under] treatment for any physical infirmity or chronic ail- ment, or injury of any nature, or [that] [I] [have] [ever] [had] a [condition] [which] [or] [have] [ever] [had] corrective [devices], and that I have never been [refused] [or] [denied] [insurance] for any [illegible] [reason]
1) Cardiac or pulmonary condition or [disease] 2) High or low blood [pressure] 3) Fainting [spells] or [convulsive] [fits] 4) [Mental] or [emotional] [illegible]
5) Nervous disorder 6) [Diabetes] 7) [Bone] or related [disorders]
5. [signature]
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IMPORTANT -- AFTER READING, SIGN AND RETURN THIS SIDE TURN FORM OVER -- READ AND COMPLETE OTHER SIDE [illegible additional text]
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b6 b7C
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DB-Cooper-26853