GUARDIAN APPLICATION FORM

00:00

Until your session expires

Your Details

Title

First Name*

Middle Name

Last Name*

Suffix

Email*

Phone number

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

Required

Characters Remaining: 500

Applicants Date of Birth

Required

Characters Remaining: 500

Guardians Age

Required

Characters Remaining: 500

Guardians Weight

Required

Characters Remaining: 500

Guardians Gender

Required

Guardians Occupation

Optional

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

Optional

Characters Remaining: 500

Are you a veteran?

Required

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

Optional

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How did you hear about Honor Flight?

Optional

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Why are you volunteering for Honor Flight?

Optional

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Please list any prior volunteer experience (if any)

Optional

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

Required

If yes, please name the veteran AND relationship to you

Optional

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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?

Required

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

Required

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

Optional

Characters Remaining: 500

Please list an emergency contact

Emergency Contact First Name

Required

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Last Name

Required

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Emergency Contact Address

Emergency Contact Address Line 1

Required

Characters Remaining: 500

Emergency Contact Address Line 2

Optional

Characters Remaining: 500

Emergency Contact City

Required

Characters Remaining: 500

Emergency Contact State

Required

Characters Remaining: 500

Emergency Contact Zip Code

Required

Characters Remaining: 500

Emergency Contact Country

Optional

Characters Remaining: 500

Emergency Contact Phone Number

Required

Characters Remaining: 500

Emergency Contact Email Address

Optional

Characters Remaining: 500

Please list one personal reference below

Personal Reference First Name

Required

Characters Remaining: 500

Alternate 1 Last Name

Required

Characters Remaining: 500

Address

Personal Reference Address Line 1

Required

Characters Remaining: 500

Personal Reference Address Line 2

Optional

Characters Remaining: 500

Personal Reference City

Required

Characters Remaining: 500

Personal reference State

Required

Characters Remaining: 500

Personal Reference Zip Code

Required

Characters Remaining: 500

Personal Reference Country

Optional

Characters Remaining: 500

Personal Reference Phone/Cell Number

Required

Characters Remaining: 500

Personal Reference Email Address

Optional

Characters Remaining: 500

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

Required

If yes, please provide group name or identifying information.

Optional

Characters Remaining: 500

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

Required

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)

Required

Characters Remaining: 500

Date

Required

Characters Remaining: 500

PARENT / GUARDIAN SIGNATURE (Please type name)

Optional

Characters Remaining: 500

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

Optional

Characters Remaining: 500

Upload a scan of a driver's license

Optional

Formats: File types allowed: PNG, PDF, JPG.
Max file size: 10MB

Additional Documents

Optional

Formats: File types allowed: PNG, PDF, JPG.
Max file size: 10MB

By clicking I agree to the terms.

Your Details

Additional Information For Your Application(s)

1 X Guardian Application Form

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