Honor Flight

At this time we are only accepting Guardian applications that are associated with a Veteran. Spouses are not eligible to serve as guardians at this time.

Please enter the name of the Veteran that you are hoping to accompany.

Veteran's First Name

Veteran's Last Name

Honor Flight Northeast Indiana, Inc., a hub affiliated with the Honor Flight Network, (“Honor Flight”) would not be successful without the generous support of our guardians. Thank you for your support! Guardians play a significant role on every trip, ensuring that every veteran has a SAFE and memorable experience. Duties include, but are not limited to, physically assisting veterans at the airport, during the flight and at the memorials. Guardians are responsible for their own expenses (flight donation, souvenirs, etc.). For further information, please contact us at (260) 633-0049 or at honorflightnei@gmail.com. All information provided on this application is for Honor Flight purposes only.

Personal Information

First Name

Middle Name

Last Name

Gender

Date of Birth

Shirt Size

ID Type

ID Number

Issuing State

Phone Number

Alternate Phone

Email Address

Street Address

City

State

Zip

Service Information

I have served in the following branch

Hometown

Alternate Contact

In the event that we have difficulty contacting you, who would you like to reach out to?

First Name

Last Name

Phone Number

Relationship

Emergency Contact

In the event that there is an emergency on flight day, who would you like us to contact?

First Name

Last Name

Phone Number

Relationship

Please review the following information for accuracy before submitting.

Personal Information

Name

Gender

Date of Birth

Shirt Size

ID Type

ID Number

Issuing State

Address

Phone (Best Reachable)

Alternate Phone

Service Information

I have served in the following branch(es)

Contact Information

Alternate Contact

()

Emergency Contact

()

Medical Information

Do you use mobility equipment?

Do you have a Pacemaker?

Do you have a Defibrillator?

Are you a Diabetic?

Do you have drug allergies?

Do you have any food allergies?

Do you have any dietary restrictions?

Have you ever had a seizure?

Please indicate all the medications you are taking and the frequency of each medication

None

Do you have problems with motion sickness?

Do you have breathing problems? (i.e. Asthma, COPD, shortness of breath, etc)

Can you walk all day, pushing a wheelchair if necessary, which may include up and down various inclines?

Do you use a home nebulizer machine?

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

Have you ever experienced issues during flight related to head injuries, sinus problems or ear problems?

Do you require a seatbelt extender on an airplane?

General Information

What is your relationship to your veteran?

Any Additional comments or concerns

Please review carefully and sign

I, the undersigned, acknowledge, and agree that:

I, the undersigned, acknowledge, and agree that: As photographic and video equipment are frequently used to memorialize and document Honor Flight trips and events, my image may appear in a public forum, such as the media or a website, 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 permission for my image, captured during any Honor Flight activities through video, photo, or other media, to be used for purposes of Honor Flight promotional material and publications, and waive any rights to compensation or ownership thereto.

ONCE SELECTED AND ASSIGNED TO A FLIGHT, EACH GUARDIAN MAKES A $400 DONATION, BEFORE THE FLIGHT, TO COVER A PORTION OF YOUR PARTICIPATION IN THE FLIGHT.

I am solely responsible for obtaining medical insurance and I understand that Honor Flight does NOT provide medical care. I have discussed the information reflected in this application and my medical limitations with my doctor, and I accept all risks associated with travel and all other Honor Flight activities. I further agree, without limitation, on behalf of myself and any of my heirs, successors or assigns, to indemnify, defend and hold Honor Flight (including, without limitation, any officers, directors, employees, members, participants, users, volunteers or agents) wholly harmless for any injuries or any losses incurred by me while participating in any Honor Flight program.

Please sign here

Typing your name in the box below will serve as your signature.

GUARDIAN APPLICATION