FOR FLIGHTS OUT OF SIOUX FALLS, SD (FSD)

NOTICE: This is the GUARDIAN APPLICATION; Veterans and Volunteers will find a separate application online. Guardians must be at least age 16 at the time of the flight and may NOT be the spouse of a veteran on flight.

Midwest Honor Flight 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 Veteran at the airport, during the flight and at the memorials. It costs Midwest Honor Flight $650 for each person that joins us – we ask Guardians to come up with a donation of at least $500. For further information, please contact us a (712) 463-2020 or visit us at www.midwesthonorflight.org.

FULL Name

Middle Name

Nick Name

Mailing Address

State County

Primary Phone Number

Secondary Phone Number

Confirm Email

Date of Birth

Age

Gender

Male
Female

T-Shirt Size

If there is specific Veteran you would like to fly with you, please enter their name and relationship to you here.

Which dates during the year do not work for your schedule?

How did you hear about Honor Flight?

Alternate Contact Name

Relationship to Guardian

Phone Number

Confirm Email

Mailing Address

Emergency Contact Name

Relationship to Guardian

Primary Phone Number

Secondary Phone Number

Are you a veteran of the US Military

Rank

Where did you serve?

**PLEASE NOTE THIS DISCLOSER DOES NOT ELIMINATE YOUR CHANCES OF GUARDIANSHIP, IT IS FOR US TO PREPARE FOR THE SAFETY OF ALL OUR VETERANS AND GUARDIANS FOR YOUR SELECTED FLIGHT**

FAILURE TO DISCLOSE MAY RESULT IN YOUR APPLICATION BEING DENIED AND NO REFUND ISSUED

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

Can you lift 100 pounds or more?

PLEASE LIST EACH MEDICATION YOU CURRENTLY TAKE FOLLOWED BY HOW OFTEN YOU TAKE IT. SHOULD YOU HAVE MULTIPLE MEDICATIONS, PLEASE LIST EACH ONE SEPARATE WITH A COMMA IN BETWEEN.

IF YOU PREFER, YOU MAY UPLOAD THE MEDICATION LIST USING THE LINK BELOW.

Medication List

Browse

List any drug allergies if applicable

Please identify any physical disabilities, restrictions and/or medical conditions that would limit your ability to fulfill the duties of a guardian.

Do you have a history of open head injuries, sinus problems, or ear problems?

If yes, have you flown since the open head injury, sinus or ear problems occurred?

If yes, did you have any problems?

Please list any medical experience that you have (i.e. EMT, CPR Trained)

Additional Comments or Concerns We Should Know

PLEASE REVIEW CAREFULLY AND SIGN:

1. As photographic and video equipment are frequently used to memorialize and document Midwest 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 Midwest Honor Flight program. I hereby release the photographer and Midwest Honor Flight from all claims and liability relating to said photographs. I hereby give permission for my images captured during Midwest Honor Flight activities through video, photo, or other media, to be used solely for the purposes of Midwest Honor Flight promotional material and publications, and waive any rights or compensation or ownership thereto.
2. I further state that medical insurance is the responsibility of the guardian and I understand that Midwest Honor Flight does NOT provide medical care. I understand that I accept all risks associated with travel and other Midwest Honor Flight activities and will not hold Midwest Honor Flight responsible for any injuries incurred by me while participating in the Midwest Honor Flight program.
3. Finally, I understand that before I am confirmed as a guardian, I must make a minimum donation of $500 (with the cost of each participant being $650) to Midwest Honor Flight at least one month prior to my scheduled Mission or whatever deadline I receive. I also understand that I must then complete one of the live Midwest Honor Flight Guardian Training program prior to the flight date. Failure to comply will either the $500 donation or live training will result in my application being terminated and no refund being issued.

I have read and agree to the terms above.

Full Name as Signature

Today's Date

Please note that if the guardian is under the age of 18 at the time of the flight, we will require a parent or legal guardian's signature on file prior to flight.

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