Guardian Application

* Indicates required field

First Name *

Last Name *

Preferred Name for badge *

Email *

Phone Number *

Ext. *

Address Line 1 *

Address Line 2 *

City *

State/Province *

Postal Code *

Country *

Date of birth *

Are you a veteran? *

Yes No

Please indicate branch of service, and where and when you served *

Are you requesting to travel with a specific veteran *

Please check the box below to agree

The undersigned acknowledges and agrees that: 1. As photographic and video equipment are frequently used to memorialize and document Honor Flight trips and events, his/her image may appear in a public forum, such as the media or a website, to acknowledge, promote or advance the work of the Honor Flight program. I hereby release the photographer and Honor Flight from all claims and liability relating to said photographs. I hereby give permission for my images captured during Honor Flight activities through video, photo, or other media, to be used solely for the purposes of Honor Flight promotional material and publications, and waive any rights or compensation or ownership thereto. 2. I further state that medical insurance is the responsibility of the veteran and I understand that neither Honor Flight nor the provider of free private aircraft ("Flight Provider") provides medical care. I understand that I accept all risks associated with travel and other Honor Flight Network activities and will not hold Honor Flight, the Flight Provider, or any person appearing or quoted in any advertisement or public service announcement for or on behalf of Honor Flight responsible for any injuries incurred by me while participating in the Honor Flight program. *

Agree

Please type your name below as a digital signature *

Gender *

Please list any prior volunteer experience *

Medical / Physical Requirements

Are you able to push a veteran in a wheelchair up a slight incline *

Yes No

Can you lift 100 pounds *

Yes No

Do you have any food, drug or insect allergies? *

Yes No

Please identify any physical disabilities, restrictions and/or medical conditions that would limit your ability to fulfill the duties of a guardian. Also, please list any medications being taken and how often *

Please note any medical experience you may have (e.g., EMT, CPR, Paramedics) *

Occupation *

Personal Reference

Personal Reference name *

Personal Reference Relationship to applicant *

Reference Address *

Reference Phone *

Emergency Contact

Emergency Contact Name *

Emergency Contact Relationship to applicant *

Emergency contact phone *

Emergency Contact Address *

Submit