Uphaven Flight Request Form

Flight Request
Uphaven is here to help children and their families access the care they need by providing free, non-emergency transportation.

Especially for first-time passengers, we kindly ask for 5 business days’ notice. This allows us the time it can take to obtain a Treatment Site Verification & Medical Release from the child's physician and submit your flight request to our network of dedicated volunteer pilots. The more advance notice you give us, the better we can plan and serve your travel needs.

We will do everything we can to support your request. A family’s safety, however, is our top priority, and inclement weather, mechanical issues, pilot availability, etc. can sometimes prevent a request from being fulfilled. All passengers must have a backup plan in place before we can confirm a flight. This could include rescheduling your appointment, driving, or exploring other travel options to ensure your care isn’t delayed.

Here's a quick rundown of our services and family requirements:

Who we serve.

- Children (18 years or younger) and their families.

- Families receiving care at a Milwaukee-area healthcare facility.

- Families needing to travel approximately 2hrs -8hrs (drive time) to/from Milwaukee.

Passenger requirements.
- Must be medically stable and require no medical assistance during a flight.
- Must be able to walk, climb stairs, and get into an aircraft seat without help.
- The use of oxygen is allowed. Any extra medical needs will be reviewed individually.
- Be ready to provide your doctor's contact info to complete an Authorization to Release Medical Information Form.
- Be able to fly in a small, 4-6 seat, non-pressurized aircraft.
- Be willing to sign a Passenger Liability Waiver Form.
- Have a backup plan in case a flight cannot happen due to pilot or aircraft availability, weather, etc.
Note: We’re working hard to grow our reach and improve how quickly we can fulfill requests. This includes building up our resources to better support urgent family transport needs.

Even if your travel doesn’t meet all our current criteria, we still encourage you to submit a request. While we can’t guarantee support in every case, sharing your story gives us valuable insight into how we can better serve you and others who rely on Milwaukee-area medical care, both now and as more resources become available.

Check out our Frequently Asked Questions to learn about our volunteer pilots and drivers, and find answers to many common questions.
I have read the above information about who Uphaven serves and the Passenger Requirements, and I agree that my request meets these requirements.*

YesNoUnsure
If you're unsure whether your flight request will meet Uphaven's requirements, we encourage you to reach out to us to learn more at (414) 207-4567 or operations@flyuphaven.org. We're here to help navigate the process with you!
If you don't believe your flight request will meet Uphaven's requirements, we encourage you to reach out to us at (414) 207-4567 or operations@flyuphaven.org. We'd like to understand the gaps in our service and we'd appreciate any feedback you'd be willing to share!
How did you hear about Uphaven?*
Click below to start your flight request. If you need any help, we're here for you at (414) 207-4567 or operations@flyuphaven.org.

Requestor and Parent/Guardian Contact Information
Please describe your relationship to the family/child needing transportation:*

Friend or RelativeSocial WorkerPhysician or Physician’s Office StaffOther Healthcare ProfessionalLodging StaffOther
Requestor Name*

First NameLast Name
Requestor Email*
example@example.com
Requestor Phone Number*
Name of primary Parent/Guardian contact*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Child's Medical Information

Please provide information about the child being cared for at a Milwaukee-area healthcare facility. This information will only be used to verify eligibility for a flight.
Full Name of the child receiving medical care (matching medical records)*

First NameMiddle NameLast Name
Nickname or preferred name if different than above
Child's Date of Birth*

MonthDayYear
Child's Healthcare Treatment Facility Name (in the Milwaukee area)*
Child's Healthcare Treatment Facility Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Will the child be traveling on this specific flight?*

YesNo
Child's Gender*
Child's Weight (lbs.)*
Weight is an important part of a pilot's weight & balance safety calculations in smaller aircraft.
Does the child require supplemental oxygen on board?*

YesNo
Medical/Mobility Equipment description and weight:*
Please provide the total weight of any medical equipment (oxygen tank, concentrator, suction machine, etc.) or mobility equipment (wheelchair, walker) that the child would require for a flight. Please provide a description including dimensions.

Passenger Information
Please list all passengers, including parents/guardians, that will be on the requested flight. You do NOT need to include the child being cared for in this section (information about the child receiving medical care has already been collected on the previous page). Keep in mind that the aircraft being used is typically a small, 4-6 passenger aircraft (including the pilot) with limited capacity.

Please be as accurate as possible. This information is required in part by the Federal Aviation Administration, and accurate weights are critcal for our pilots to perform safe weight & balance calculations in small aircraft.

For passengers who are children, please list their Parent/Guardian's phone number and email address (for purposes of collecting a signed Liability Waiver).
Passengers*
Due to space and weight considerations in smaller aircraft, we limit luggage to 25 lbs. per person, with a maximum of 50 lbs. total for all passengers. Luggage should be soft-sided and similar to commercial carry-on sizes. Uphaven pilots may be able to accommodate extra baggage if you inform us in advance. Final authority will rest with our pilot and driver volunteers.

Note that this 50 lb. limit does not apply to any medical equipment listed previously in your request.
I understand that luggage is limited to 25 lbs. per person, with a maximum of 50 lbs. total for all passengers, and our flight will be able to meet that requirement.*

YesNo
If you believe you may need to bring extra baggage beyond the 50 lb. limit, please continue with submitting your flight request. We will reach out to you to discuss your unique situation.
Emergency Contact (not traveling with the family)*

First NameLast Name
Emergency Contact Phone Number*
Should be Empty:

Flight Request

Trip Information

Requestor and Parent/Guardian Contact Information

Child's Medical Information

Passenger Information