HONOR FLIGHT NETWORK
CENTRAL PRAIRIE HONOR FLIGHT
LOCAL INFORMATION AVAILABLE THROUGH "CENTRAL PRAIRIE RC&D"
1817 16th Street; Great Bend, KS 67530; [email protected]
Guardian Application
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, but not limited to, physically assisting the veterans at the airport, during the flight and at the memorials. Guardians are also responsible for their own expenses (airline fare, etc).
For further information, please contact us at (620) 792-6224 or visit us at www.honorflight.org
DATE: ________/____________/__________
Month Day Year----
YOUR NAME:____________________________________________________________ NICK NAME:______________________________________________
(As it appears on your ID for airline travel) (If Applicable)
ADDRESS:_________________________________________________________________________________________________
CITY:_____________________________________________________ STATE:_____________________ ZIP:_______________
PHONE: Day:______________________ Evening:__________________________ Cell Phone:________________________
E-MAIL ADDRESS:_______________________________________________WEIGHT:________________ AGE: __________
OCCUPATION:_________________________________ARE YOU A VETERAN? YES____________NO___________
If a veteran, please indicate BRANCH of service, and WHEN and WHERE you served: _____________________________________
TEE SHIRT SIZE: (S,M,L,XL,XXL,X ____________
1. How did you learn about the Honor Flight organization?_______________________________________________________________________
2. Why are you volunteering for Honor Flight?___________________________________________________________________________________
3. Please list any prior volunteer experience?____________________________________________________________________________________
______________________________________________________________________________________________________________________________
4. Please list one (1) personal reference:
Name:__________________________________________________________________Relationship to applicant:____________________________
Address:_____________________________________________________________________________________________________________________
City/State/Zip:______________________________________________________________________________________________________________
Phone Numbers: Day______________________________________________ Evening:________________________________________________
5. Please list one (1) emergency contact:
Name:__________________________________________________________________Relationship to applicant:____________________________
Address:_____________________________________________________________________________________________________________________
City/State/Zip:______________________________________________________________________________________________________________
Phone Numbers: Day______________________________________________ Evening:________________________________________________
6. Please identify the city(ies) from which you would be able to fly as a Guardian. For a list of active cities, visit "Regional Programs"
on our website at: http://www/honorflight.org/regional
City(ies)______________________________________________________________________________________________________________________
PLEASE COMPLETE BACK PAGE
LOCAL INFORMATION AVAILABLE THROUGH "CENTRAL PRAIRIE RC&D"
1817 16th Street; Great Bend, Ks. 67530; 620-792-6224; [email protected]
(In the following questionnaire please check the correct response)
7. Are you requesting to travel with a specific veteran, if possible? YES_________ NO __________
If YES, please name the veteran: ______________________________________________________________
(Please note that a completed "Veteran Application" must be submitted separately)
_______________________________________________________________________________________________________
8. Can you lift 100 pounds? YES _____________ NO ______________
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9. Please identify any physical disabilities, restrictions and/or medical conditions that would limit your ability to fulfill the duties of a guardian. Also, please list any medications being taken and how often.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
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10. Please note any medical experience you may have (e.g., 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 Flights 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 Honor Flights program. I hereby release the photographer and Honor Flights from all claims and liability relating to said photographs. I hereby give permission for my images captured during Honor Flights activities through video, photo, or other media, to be used solely for the purposes of Honor Flight promotional material and publications, and wave any rights or compensation or ownership hereto.
(2) I further state that medical insurance is the responsibility of the veteran and I understand that 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:________/__________/__________ (e-mail applicants will be required to sign prior to actual flight date)
*If under 18, a parent/guardian must also sign and date below
SIGNATURE:_______________________________________________ DATE:__________/__________/____________
PARENT/GUARDIAN
Send this application to:
Central Prairie Honor Flight
C/O Central Prairie RC&D Council
1817 16th Street
Great Bend, Kansas 67530
Fax your Veterans Application to: 620-792-4875 or contact us by Phone at: 620-792-6224
Donations are welcome * A letter acknowledging this donation will be mailed to the designated donor
All programs and services of Central Prairie RC&D and their "Honor Flight" program are offered on a non-discriminatory
basis without regard to race, color, national origin, age, marital or family status, disability, or political beliefs.