FOR FLIGHTS OUT OF SIOUX FALLS, SD (FSD)





SERVICE HISTORY


MEDICAL INFORMATION PROVIDED WILL NOT DISQUALIFY YOU.  IT PERMITS US TO ASSESS THE SUPPORT WE NEED DURING THE TRIP.  INFORMATION IS MIDWEST HONOR FLIGHT PERSONNEL ONLY.

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.











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. I understand that there are waiting lists of veterans who have applied before me and understand that Midwest Honor Flight flies veterans, at no cost to them without governmental funding, with the policy of “first to apply, first to fly” with priority always given to any WWII veteran or terminally ill veteran. Failure to completely fill out the entirety of this application may result in my application being return to me or not considered for flights.

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