HomeMy WebLinkAboutHonor Flight Application FormHONOR FLIGHT of EASTERN OREGON GUARDIAN APPLICATION
Thank you for contacting HONOR FLIGHT of EASTERN OREGON and offering to help
make the dreams come true for World War II veterans when they visit THEIR national WWII
Memorial in Washington, DC. As a guardian, it will be your responsibility to care for 1-3
veterans as though they are family members. Guardians will be provided a detailed list of
responsibilities before the trip. The tour is provided free to veterans. The total cost for a
guardian including air fare, meals, bus, and lodging for a trip from Portland, OR to Washington
DC and return can be $1,200 more or less depending on air fares at the time we purchase
tickets. Guardian fees might not be refundable if the guardian cancels within 30 days from
the trip’s beginning date. Do not forward your payment until you are notified of your
flight date and fee. If you have any questions please call us at 541 388-5591 or 541 390-9932.
YOUR NAME: _______________________________________________ NICKNAME: _________________
(As it appears on your ID for airline travel)
ADDRESS: ______________________________ City ______________________State____ Zip____________
PHONE: Day _______________________ Night ________________________ Cell _____________________
Date of Birth: ____________ WEIGHT ______ TEE SHIRT SIZE: S M L XL XXL XXXL
EMAIL ADDRESS: ___________________________________ OCCUPATION ______________________
Why are you volunteering for Honor Flight? ____________________________________________________
_______________________________________________________________________________________
Please list any previous volunteer experience: ___________________________________________________
Please list one personal reference: _____________________________________________________________
Name:____________________________________________ Relationship to veteran: ___________________
Address: _________________________________________________________________________________
City: _________________________________________ State: _________________ Zip: ________________
Email address ____________________________________________________________________________
Phone numbers: Day: _________________________________ Night: _______________________________
Please list an emergency contact:
Name: __________________________________________________________________________________
Address: _________________________________________________________________________________
City: __________________________________________State: __________________Zip: _______________
2
Phone numbers: Day: _________________________________Night: _______________________________
Are you willing to travel with a specific veteran? Yes: __________ No: _____________________
If yes, please name the veteran: ________________________________________. The veteran must submit a
completed application separately and at the same time as the guardian.
Guardians must be in good health and willing to share a room with a veteran. Are you able to push a veteran in
a wheelchair up a slight incline? Yes: ___________ No: ______________
Can you lift 50 pounds? Yes __________________ No _______________
Can you walk unaided 300 feet? Yes: _____________ No: ______________
Please identify any physical disabilities, restrictions and /or medical conditions that could limit your ability to
fulfill the duties of a guardian. Also list any medications being taken and how often. _____________________
Do you have any medical experience? (Doctor, Nurse, EMT, CPR, Paramedics) _________________________
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 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 my permission for my images captured
during Honor Flight activities through video, photo, or other media, to be used for the purposes of
Honor Flight promotional material and publications and waive any rights or compensation or
ownership thereto. I agree that my name may be shared with other veterans participating on Honor
Flight of Eastern Oregon trips.
2 I further state that medical insurance is the responsibility of the guardian and I understand the Honor
Flight does not provide medical care. I understand that I accept all risks associated with travel and other
Honor Flight activities and will not hold Honor Flight responsible for any injuries incurred by me
while participating in the Honor Flight program.
SIGNED: ______________________________________DATE:______/______/______
Please mail completed form to: Honor Flight of Eastern Oregon, 1900 NE 3rd St., Suite 106 #205,
Bend, OR 97701 Phone 541-388-5591, 541-390-9932 email: dtobiason@bendcable.com
Guardian fees may be tax deductible. Consult your accountant, tax preparer.