GUARDIAN APPLICATION FORM

Contact Info

Title

First Name*

Middle Name

Last Name*

Suffix

Email*

Phone

Ext

Work
Mobile
Home

Address Line 1*

Address Line 2

City*

State/Province*

Postal Code*

Country *

Additional Information for Your Application(s)

1 X Guardian Application Form

Please INITIAL and DATE that you have read the above information and proceed to the application

Applicants Date of Birth*

Guardians Age*

Guardians Weight*

Guardians Gender*

Guardians Occupation

Please note any medical experience you may have as a firefighter, EMT, medic, nurse, physician, etc.

Are you a veteran?*

If a veteran, please indicate branch of service, when and where you served

How did you hear about Honor Flight?

Why are you volunteering for Honor Flight?

Please list any prior volunteer experience (if any)

Are you requesting to be a guardian for a specific veteran?*

If yes, please name the veteran AND relationship to you

PLEASE NOTE:A veteran application must be submitted separately. Spouse or significant other are not eligible to be a guardian to a veteran.

Are you able to push 250 pounds for one mile?

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

Please list any physical disabilities, restrictions, or medical conditions that may limit your ability to fulfill the duties of a guardian

Please list an emergency contact

Emergency Contact First Name

Last Name

Emergency Contact Address

Emergency Contact Address Line 1

Emergency Contact Address Line 2

Emergency Contact City*

Emergency Contact State*

Emergency Contact Zip Code*

Emergency Contact Country

Emergency Contact Phone Number*

Emergency Contact Email Address

Please list one personal reference below

Personal Reference First Name

Alternate 1 Last Name

Address

Personal Reference Address Line 1

Personal Reference Address Line 2

Personal Reference City*

Personal reference State*

Personal Reference Zip Code*

Personal Reference Country

Personal Reference Phone/Cell Number*

Personal Reference Email Address

Are you traveling with other guardians or with a specific group of guardians?*

If yes, please provide group name or identifying information.

Your T-Shirt size (Shirts run a little small)*

PLEASE REVIEW CAREFULLY BEFORE SUBMITTING: The applicant understands, acknowledges and agrees: That as a condition to being a Volunteer and/or Guardian on an Honor Flight mission, I will be doing so at my own risk. Honor Flight, Inc., Southeast Florida Honor Flight, Inc., as well as their agents, staff, volunteers, officers, sponsors, etc., shall not be held liable for, and are hereby released from any claims, liabilities, losses, damages, costs or expenses related to or arising out of any injury to my person or property. I personally hereby forever release, acquit, discharge, indemnify and hold harmless the aforementioned entities, its agents, officers and employees, etc., from any and all causes of action including personal liability, illness, death, property damage, costs, charges, claims demands and liabilities of any kind. It shall be further understood that any and all medical and/or cancellation insurance is the responsibility of the applicant, volunteer and/or guardian. I shall also give permission for the free use of my name and photo likeness in broadcast, telecast, written, pictorial accounts and promotions of Honor Flight, Inc. and Southeast Florida Honor Flight, Inc. The Guardian fee of $400 is payable once confirmed for a flight and prior to Guardian Training. I have read and understand the terms of this application and have signed voluntarily. SIGNATURE (PLEASE TYPE NAME)*

Date*

PARENT / GUARDIAN SIGNATURE (Please type name)

Applicants under 18 will require an exception/waiver from the governing board of Southeast Florida Honor Flight. If exception granted, parent and/or legal guardian must also sign and date.

Please do not send guardian donation until contacted by our guardian coordinator and you are confirmed for flight.

Date

Upload a scan of a driver's license

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Additional Documents

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Max file size: 10MB

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