Veteran Application

Honor Flight recognizes American Veterans for your sacrifices and achievements by flying you to Washington DC to see YOUR memorial at no cost. We are currently accepting applications for Veterans from all wars with top priority given to terminally ill veterans. Dates of service, age and application date will determine the order in which Veterans are chosen for each flight. In order for Honor Flight to achieve this goal, guardians fly with the veterans on every flight providing assistance and helping all veterans have a safe and memorable experience. For what you and your fellow Veterans have given to us, please consider this flight a small token of appreciation from all of us at Honor Flight. For further information, please call 563-690-0815 or visit us at www.honorflightdbq.org.

PLEASE NOTE:

Your spouse CANNOT be your guardian

Your Information

Please list your full first, middle, and last name as it appears on your driver’s license or government ID.

First Name *Full First Name (no nicknames or shortened names)

Middle Name *Full Middle Name

Last Name *Full Last Name

Street Address *

Apartment, suite, etc

City *

State *

ZIP Code *

Best Contact Phone Number *

GenderMaleFemale

Email Address

Weight

Age

Date of Birth

Shirt Size

Service History:

Branch

War/Conflict

What years did you serve?

Alternate Contact (son, daughter, etc.) NameThis person should not be the same person as your Emergency Contact

Relationship

Best Contact Phone Number

Emergency Contact Information

(Person to contact the day you travel.)

Name

Relationship

Street Address

City

State

ZIP Code

Best Contact Phone Number

Guardian Request

Are you requesting to travel with a specific Guardian if possible?YesNo

Name of requested guardian

There are NO GUARANTEES they will be chosen. Completed Guardian Application must be submitted separately.

Medical Information

The information provided will not disqualify you. It permits us to assess the support we need during the trip. Information is for Honor Flight and medical personnel only.

Do you have problems walking the length of a football field without assistance?YesNo

If yes, please describe the reason (lungs, arthritis etc.)

List medications

Do you have allergies?YesNo

If yes, what are they?

Do you have a history of seizures?YesNo

If yes, grand mal, petit mal, other

If your last seizure was within the past 5 years, please discuss trip with your physician.

Do you have problems with motion sickness?YesNo

If yes, is it controlled with medication

Do you have breathing problems?YesNo

If yes, do you use oxygen?

If yes you will need a prescription from your physician for oxygen to be used on the trip. The oxygen will be provided. The prescription should be turned in with this application.

Do you use a home nebulizer machine?YesNo

If yes, we strongly suggest you discuss this trip with your physician concerning the use of a portable hand-held nebulizer during the trip.

If YES, it is strongly advised you discuss the trip with your private physician. If you have never flown since having this condition, we again strongly advise that you discuss this trip with your doctor.

Do you have a urostomy or colostomy bag?YesNo

If yes, make sure the bag is vented prior to the flight. If you do not know if the bag is vented, we strongly advise that you discuss this with your physician.

Additional comments or concerns:

Effective May 7, 2025 you must have the Gold Star on your Driver's License and /or your ID card to be on an Honor Flight.

Do you have the Gold Star on your Driver License?YesNo

If you do not have the Gold Star as of May 7, 2025 you will not be allowed to fly. (Allow 3 to 6 weeks to have the Star added.)

SignedBy typing your name, you acknowledge the above.

Date *