Guardian Application

Honor Flight of Central Oregon would not be successful without the generous support of our guardians. Guardians play a significant role on every trip, ensuring that every veteran has a safe and memorable experience. Duties include physically assisting the veterans at the airport, during the flight, and at the memorials. Guardians are also responsible for a donation of approximately $1,500 to cover their own expenses (airline, hotel, etc Thank you for your support. Due to National

Honor Flight requirements. Guardians must be one generation removed from veterans on flight.

(Use your full name as it appears on your driver's license or government ID)

YOUR NAME

NICKNAME

Gender M/F

ADDRESS

CITY

COUNTY

STATE

ZIP

Evening

Day

Cell

EMAIL

example@example.com

AGE

DOB

OCCUPATION

WEIGHT

ARE YOU A VETERAN?YN If YES, Branch of Service and When?

Y/N

YES, Branch of Service and When?

1. How did you learn about Honor Flight?

2. Why are you volunteering for Honor Flight?

3. Please list any prior volunteering experience?

4. Please list one (1) personal reference:

Name

Relationship to applicant

Address

City

State

Zip Code

Email address

example@example.com

Phone: Day

Evening

5. Please list one (1) emergency contact:

Name

Relationship to applicant

Address

City

State

Zip Code

Email address

example@example.com

Evening

Day

7. Are you requesting to travel with a specific veteran? Y/N

Y/N

8. If YES, please name the veteran: (Please note that a veteran application will need to be submitted separately)

9. Are you able to push a wheelchair up a slight incline?

Y/N

N 10. Can you lift 100 pounds? Y/N

Y/N

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

12. T Shirt Size (S, M, L, XL, 2XL, 3XL, 4XL)

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

PLEASE REVIEW CAREFULLY AND SIGN

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 walve any rights or compensation or ownership thereto.

2.I further state that medical insurance is the responsibility of the guardian 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.

(Email applicants will be required to sign prior to actual trip)

DATE

Date

*If under 18, a parent/guardian must also sign and date below

(Parent/Guardian)

DATE

Date