Central Missouri Honor Flight
KOMU-TV
5550 Highway 63 S
Columbia, MO 65201
United States
ph: (573) 301-5657
alt: (573) 882-8888
centralm
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CENTRAL MISSOURI HONOR FLIGHT
GUARDIAN APPLICATION
CM 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 and lifting 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 Barbara Brueggeman at (573) 301-5657 or email: centralmissourihonorflight@yahoo.com
Unfortunately, CM Honor Flight typically has many more applications for guardian status than is required on our flights. CM Honor Flight must insure that the highest degree of safety is provided for our veterans in our care while maximizing the number of veterans we transport. Once a determination is made on the number of guardians required on a flight, the following selection criteria are followed in choosing guardians:
Thank You for your support.
Please print name as it appears on your photo ID (needed for TSA)
NAME:_____________________________________________________________________________
FIRST MIDDLE LAST
NAME on name tag:__________________________________________________________________
ADDRESS:___________________________________________________________________________
CITY:__________________________________________STATE:______________ ZIP:______________
PHONE: DAY:______________________ EVENING:__________________ CELL: ___________________
E-MAIL ADDRESS:___________________________________ AGE:______________DOB:___________
OCCUPATION:_______________________________________________________________________
ARE YOU A VETERAN? YES:_____NO: _____ BRANCH OF SERVICE:____________________________
ARE YOU A VETERAN OF THE KOREAN WAR? _________ VIETNAM WAR?_________
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: _____________________________
E-Mail Address: _______________________________________________________________________
Phone Numbers: Day:___________________________ Evening: ________________________________
5. Please list one (1) emergency contact:
Name: ________________________________________Relationship to applicant: _________________
Address:__________________________________________City/State/Zip: _______________________
E-Mail Address: _______________________________________________________________________
Phone Numbers: Day:__________________________________ Evening: ________________________
6. Are you requesting to travel with a specific veteran, if possible? Yes: ________ No: __________
If yes, please name the veteran and relationship: (Completed veteran application must be submitted also)
____________________________________________________________________________________
7. Are you able to push a veteran in a wheelchair up a slight incline? Yes: _____ No: _____
8. Can you lift and carry 100+ pounds? Yes :_____ No:______
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. _____________________________________________________________________________________
_____________________________________________________________________________________
10. T-Shirt Size: (M, L, XL, XXL, XXXL) _________
11. Please note any medical experience and/or training you may have (e.g., EMT, CPR, Paramedic, R.N.?) _____________________________________________________________________________________
12. Have you previously served as an Honor Flight Guardian?___________________________________
When and where?______________________________________________________________________
PLEASE REVIEW CAREFULLY AND SIGN:
The undersigned acknowledges and agrees that:
SIGNATURE: ________________________________________________ DATE:_____/_____/______
(E-mail applicants will be required to sign prior to actual trip date)
Please submit this form to:
Central Missouri Honor Flight
ATTN: Guardian Application
c/o KOMU TV
5555 Highway 63 South
Columbia, MO 65201
Or e-mail to: centralmissourihonorflight@yahoo.com
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Central Missouri Honor Flight
KOMU-TV
5550 Highway 63 S
Columbia, MO 65201
United States
ph: (573) 301-5657
alt: (573) 882-8888
centralm