Central Missouri Honor Flight

 

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:

 

• Is the applicant medically trained in areas that would be of assistance on a flight?
• Is the applicant an experienced Honor Flight guardian and is available to go in a leadership position (i.e. bus captain, team leader, etc.)?
• Is the applicant a Korean or Vietnam War veteran who is physically able to assist a guardian AND visit their memorial(s) as well?
• Is the applicant a caretaker for a terminally ill veteran or caretaker for a veteran who requires one-on-one physical assistance? 

 

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:

 

• As photographic and video equipment are frequently used to memorialize and document CM 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 CM Honor Flight program. I hereby release the photographer and CM Honor Flight from all claims and liability relating to said photographs. I hereby give permission for my images captured during CM Honor Flight activities through video, photo, or other media, to be used solely for the purposes of CM Honor Flight promotional material and publications, and waive any rights or compensation or ownership thereto.

 

•  I further state that medical insurance is the responsibility of the guardian and I understand that neither CM Honor Flight nor the provider of aircraft ("Flight Provider") provides medical care. I understand that I accept all risks associated with travel and other CM Honor Flight activities and will not hold CM Honor Flight, the Flight Provider, or any person appearing or quoted in any advertisement or public service announcement for or on behalf of CM Honor Flight responsible for any injuries incurred by me while participating in the CM Honor Flight program.

 

• I agree and understand that I will pay for my own transportation cost (airfare – approximately  $300.00 pp)

 

 

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

 

 

 

For office use only:   Date Received:_______________________ Time:_______________________