Forms

Emergency contact's name (son, daughter, friend, etc.) *

Branch of service *

City, state, zip *

Date of Birth *

IF YOU WILL REQUIRE THE USE OF A PORTABLE OXYGEN CONCENTRATOR DURING THIS TRIP, PLEASE CONTACT YOUR DOCTOR TO REQUEST THE PROPER PAPERWORK FOR THE FLIGHT. It is highly recommended that you discuss this trip with your physician. *

I do not require the use of this type of oxygenator equipment.

I will provide the required paperwork.

Day Phone # *

Mobile Phone # *

Nickname

Name: *

Do you have a problem walking the length of a football field without assistance? *

Yes

No

Nickname

Emergency contact's phone # *

Why are you volunteering for Honor Flight? *

Evening Phone # *

Address *

Do you use a home nebulizer? *

Yes

No

If you wish to travel with another veteran or veterans, please provide their names.

Do you have a history of seizures? *

Yes

No

Evening Phone # *

If you answered Yes to any of the medical questions, please explain, otherwise enter NONE. *

Emergency contact's name and relationship *

Address *

Name: *

Occupation

Why are you volunteering for Honor Flight? *

Duty station *

Date of electronic signature *

Date and time of electronic signature *

Please identify any physical disabilities, restrictions and/or medical conditions that would limit your ability to fulfill the duties of a guardian, otherwise enter NONE *

Do you have any breathing problems? *

Yes

No

Rank *

Evening Phone # *

City, state, zip *

Email *

If you wish to travel with this person or another particular guardian (son, daughter, grandchild or friend), enter their name here. (Spouses are not eligible to be guardians. Guardians must be at least 18 years old.)

Nickname

Date of Birth *

How did you hear about Honor Flight?

Mobile Phone # *

Weight *

Email *

Emergency contact's phone # *

PLEASE REVIEW CAREFULLY AND SIGN The undersigned acknowledges through electronic signature and agrees that: 1. As photographs and video equipment are frequently used to memorialize and document Honor Flight Cleveland 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 Cleveland program. I hereby give permission for my images captured during Honor Flight Cleveland activities through video, photo or other media, to be used solely for the purpose of Honor Flight Cleveland promotional material and publications, and waive any rights or compensation or ownership thereto. 2. I understand that Honor Flight Cleveland does NOT provide medical care. I understand that I accept all risks associated with travel and other Honor Flight Cleveland activities and will not hold Honor Flight Cleveland responsible for any injuries or illness incurred by me while participating in the Honor Flight Cleveland Program. *

Do you have a history of head injuries, sinus or ear problems? *

Yes

No

If Yes, enter that veteran's name.

ONLINE GUARDIAN APPLICATION --- Honor Flight Cleveland would not be successful without the generous support of our guardians. Guardians play a vital role on every trip, ensuring that each veteran has a safe and memorable experience. Duties include, but are not limited to, physically assisting the veterans at the airport, during the flight and at the memorials. GUARDIANS ARE RESPONSIBLE FOR THEIR OWN EXPENSES (airfare, etc.)

I understand

Address *

Are you requesting to travel with a specific veteran (if possible)? *

Yes

No

Mobile Phone # *

Daytime Phone # *

Period of service *

MEDICAL INFORMATION - Information provided will NOT disqualify you! It permits us to assess the support we need during the trip. Information is for Honor Flight Medical Personnel only.

PLEASE REVIEW CAREFULLY AND SIGN --- The undersigned acknowledges through electronic signature and agrees that: 1. As photographs and video equipment are frequently used to memorialize and document Honor Flight Cleveland 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 Cleveland program. I hereby give permission for my images captured during Honor Flight Cleveland activities through video, photo or other media, to be used solely for the purpose of Honor Flight Cleveland promotional material and publications, and waive any rights or compensation or ownership thereto. 2. I understand that Honor Flight Cleveland does NOT provide medical care. I understand that I accept all risks associated with travel and other Honor Flight Cleveland activities and will not hold Honor Flight Cleveland responsible for any injuries or illness incurred by me while participating in the Honor Flight Cleveland Program. *

Email *

Please note any medical experience you may have (EMT, CPR, Nurse, Paramedic, etc.)

Daytime Phone # *

Date of electronic signature

List any medications you are taking and the frequency you take them, otherwise enter NONE. *

Emergency contact's phone # *

Would you have difficulty pushing a wheelchair? *

Yes

No

List medications being taken and frequency taken, otherwise enter NONE *

Can you lift 100 pounds? *

Yes

No

City, state, zip *

Date of Birth *

Emergency contact's name and relationship *

Do you have any drug allergies? *

Yes

No

Name: *

Do you use mobility equipment? *

Yes

No

How did you hear about Honor Flight?

Do you have any medical issues we should be aware of? *

Yes

No

PLEASE REVIEW CAREFULLY AND SIGN --- The undersigned acknowledges through electronic signature and agrees that: 1. As photographs and video equipment are frequently used to memorialize and document Honor Flight Cleveland 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 Cleveland program. I hereby give permission for my images captured during Honor Flight Cleveland activities through video, photo or other media, to be used solely for the purpose of Honor Flight Cleveland promotional material and publications, and waive any rights or compensation or ownership thereto. 2. I understand that Honor Flight Cleveland does NOT provide medical care. I understand that I accept all risks associated with travel and other Honor Flight Cleveland activities and will not hold Honor Flight Cleveland responsible for any injuries or illness incurred by me while participating in the Honor Flight Cleveland Program. *

Do you have problems with motion sickness? *

Yes

No

Occupation

How did you hear about Honor Flight? *

Celebrating Our Nation's Heroes