Honor Flight Southern Indiana | Guardian Registration Form

Guardian Information

First Name

Middle Name

Last Name

Nickname (if used)

Date of Birth

Gender

Male Female

Contact Information

Street Address

City

State

Zipcode

County

Daytime Phone

Evening Phone

Mobile Phone

Email Address

Emergency Contact

The Emergency Contact should be someone available on the day of the trip.

First Name

Last Name

Relationship

Address

City

State

Zipcode

Daytime Phone

Evening Phone

Mobile Phone

Email Address

Alternate Contact

First Name

Last Name

Relationship

Daytime Phone

Evening Phone

Mobile Phone

Email Address

Additional Information

Have you been the recipient of a previous Honor Flight trip or visited the WW II, Korean, Marine Corps or Vietnam War Memorials?

Yes No

T-Shirt Size

Are you willing to assist all veterans, and are you willing to push any wheelchair?

Yes No

Can you lift 100 pounds?

Yes No

Are you requesting to travel with a specific veteran, if possible?

Yes No

Remarks / Comments:

How did you hear about Honor Flight?

Additional Questions

Have you ever had a Heart Attack or Stroke? If so, when?:

Do you require a service animal on the flight?:

List any blood thinners you take, e.g. Aspirin, Warfarin, etc.: