Guardian Online Application

Requirements of being a guardian:

You need to pay for your trip. The current cost is $1300 which covers air and land transportation, food, lodging, attraction entrance fees, flight bag, jacket, and t-shirts.
You cannot be a veteran's spouse or significant other. If you are a different family member of a veteran you must be 16-65 years old. If you are not a family member, you need to be between 18 -65 years old. Guardians over 65 must get HFCCC Chair approval.
Your responsibility on the trip is to assist your veteran with whatever they need which may include pushing your veteran in a transport chair up to 7 miles during a single day.
You must be in good physical health, have good eyesight and hearing and be able to walk and lift 80lbs.
7-14 days before the trip there will be a mandatory Pre-Flight event and training that you must attend in order to go on the trip.
You will be part of a team along with the other guardians who will help veterans get on and off the bus and help load equipment on and off the bus. You will be part of a “bucket brigade” so you will need to be agile, mobile, able to squat, and able to lift 80 lbs.

I have read the above requirements of being a guardian and I meet those requirements. (If you choose "No" you will get an opportunity to explain)*

Please explain what would hamper your ability to fulfill the requirements of a guardian.

Full legal name as it appears on either your ID or passport (No Initials). Provide a copy of the same ID you will show at the airport.*

First Middle Last

Preferred name or nickname

Address*

Street Address City State ZIP Code

Primary phone*

Type

Secondary phone

Type

Email*

Date of Birth*

Gender*

Male
Female

Men's T-Shirt size*

Men's Jacket Size*

Are you a veteran?*

Service History

Branch of Service*

Rank (not pay grade)

When did you serve: From (month/year)*

When did you serve: To (month/year)*

In what war era(s) did you serve? (select all that apply)*

Pre Vietnam (8/1953 - 7/1964)
Vietnam (8/1964 - 5/1975)
Post Vietnam
Other

If you chose Post Vietnam or Other please specify:

Military MOS and job description

Additional comments of military history

Emergency Contact Information

Name*

Relationship*

Primary phone*

Type

Secondary phone

Type

Email

Additional Information

Are you requesting to travel with a specific veteran?*

Veteran Name*

Relationship*

Phone*

Type

Email

Do you have emergency medical training and would you be willing to use this training in a medical emergency on the trip?*

What is your emergency medical training?*

You chose Other, please describe*

Medical Information

This information will be used in case of an emergency. Information is for Honor Flight and medical personnel only. If you have a DNR and want to take it on the trip, it is your responsibility to carry it with you.

Medications*

To add more medications click the "+" at the right of the row. If you have none, enter "none".

Medication Taken	Dosage	How Often

Please list your physician's name and phone number in case of an emergency.

Physician's Name*

Phone*

Do you have any special dietary needs?*

Please check all that apply. If you choose "Other" you will have an opportunity to describe it.

None
Vegetarian
Vegan
Diabetic
Low Salt
Gluten Free
Other

You chose "Other" as a special dietary need. Please tell us what it is.

Do you have any drug allergies?*

Please list drugs that you are allergic to

Do you have a history of seizures?*

Please describe what type of siezures that you have (e.g. grand mal, petit mal, other)

Date of last seizure

If you have had a seizure within the last 5 years we strongly advise you to discuss this trip with your physician.

Do you use a CPAP?*

Does your CPAP use sterile water?*

Yes
No

Do you have other breathing problems?*

Please describe your breathing problems.

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

Have you flown since the open head injury, sinus or ear problem?

Did you have any problems when you flew before?

It is strongly advised that you discuss the trip with your physician. If you have NOT flown since the open head injury, sinus or ear problem began, we strongly advise you to discuss the trip with your physician.

Do you have urostomy or colostomy bag?*

Please make sure your bag is vented prior to flight. If you do not know if your bag is vented, it is STRONGLY advised that you discuss this with your physician.

Consent

Please Review. You will be asked to sign this later

1. 14-7 days before the trip there will be a mandatory Pre-Flight event and training that I must attend in order to go on the trip.

2. As photographic and video equipment are frequently used to memorialize and document Honor Flight Central Coast California (HFCCC), Honor Flight Network (HFN), and Welcome Home Military Heroes (WHMH) 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 HFCCC, HFN and WHMH programs. I hereby release the photographer and HFCCC, HFN and WHMH from all claims and liability relating to said images. I hereby give permission for my images captured during HFCCC, HFN, and WHMH activities through video, photo or other media, to be used solely for the purposes of HFCCC, HFN and WHMH promotional materials and publications, and waive any rights of compensation or ownership thereto.

3. I further state that medical insurance is NOT the responsibility of HFCCC or HFN. I understand that HFCCC and the HFN does NOT provide medical care. I understand that I accept all risks associated with travel and other HFCCC and the HFN activities and will not hold HFCCC and the HFN responsible for any injuries incurred by me while participating in the HFCCC and the HFN program

4. HFCCC provides flight cancellation and liability insurance for those listed on the HFCCC airline sponsored manifest.

5. Refunds will be reviewed on a case by case basis by the HFCCC Board.

6. The Veteran/Guardian agrees to indemnify and hold the Honor Flight Central Coast California (HFCCC) and its board members harmless from and against any and all claims, liability, loss, expenses, suits, damages, judgments, demands, and costs (including reasonable legal fees and expenses) arising out of (i) the acts or omissions of HFCCC or its board members in connection with Tour of Honor or related events; or (ii) any accident, injury or death to persons, or loss of or damage to property, or fines and penalties which may result, in whole or in part, on a Tour of Honor or related events.

7. I understand that the HFCCC Board reserves the right to deny any application at the Board’s discretion.

Don't worry about signing it online. We will get your signature at a later date.

Signature: ________________________________________ Date: _______________________

GuardianAppPDF_File

805-610-4012

info@honorflightccc.org

Guardian Application

Service History

Emergency Contact Information

Additional Information

Medical Information

Consent

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