On-line Veteran Application Form

LIST TWO EMERGENCY CONTACTS (SPOUSE, SON, DAUGHTER, ETC.) SOMEONE AVAILABLE THE DAYS YOU TRAVEL

MEDIA RELEASE

The undersigned acknowledges and agrees that:

1. As photographic and video equipment are frequently used to memorialize and document Honor Flight trips and events, your image may appear in a public forum, such as the media or a website, to acknowledge, promote or advance the work of the Honor Flight program. I hereby release the photographer and Western ND Honor Flight from all claims and liability relating to said photographs. I hereby give permission for my images captured by Western ND Honor Flight or its agents during Western ND Honor Flight activities through video, photo, or other media, to be used solely for the purposes of Western ND Honor Flight promotional material and publications and waive any rights, compensation, or ownership thereto.

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

COVENANT NOT TO SUE AND INDEMNITY AGREEMENT

I understand I am about to voluntarily participate in various activities, including flying activities, of the Western ND Honor Flight as a passenger. In consideration of this organization permitting me to participate in their activities, I, for myself, my heirs, administrators, executors and assigns, hereby covenant and agree that I will never institute, prosecute, or in any way aid institute or prosecution of, any demand, claim or suit against the organization known as Western ND Honor Flight for any destruction, loss, damage or injury (including death) to my person or property, which may occur from any cause whatsoever as a result of my participation in the activities of the Western ND Honor Flight organization.

If I, my heirs, administrators, executors, or assigns should demand, claim, sue or aid in any way in such demand, claim or suit, I agree, for myself, my heirs, administrators, executors and assigns to indemnify the Western ND Honor Flight organization for all damages, expenses, and costs it may incur as a result thereof.

I know, understand, and agree that I am freely assuming the risk of my personal injury, death or property damage, loss or destruction that may result while participating in Western ND Honor Flight activities, including such injuries, death, damage, loss, or destruction as may be caused by the negligence of Western ND Honor Flight organization.

I also understand and agree that I may be held liable for any damages or loss to the Western ND Honor Flight organization which is caused by my gross negligence, willful misconduct, dishonesty, or fraud and for limited damages or loss the Western ND Honor Flight organization which is caused by my simple negligence.

I further understand that the term Honor Flight organization includes the non-profit organization known as Honor Flight, any officer, agent and/or employee thereof.

EMERGENCY CARE RELEASE

I hereby authorize the Western ND Honor Flight organization, its officers, employees, members, participants, users and/or volunteers, to take the action they believe is appropriate in an emergency situation. Further, I agree to indemnify and hold harmless the Western ND Honor Flight organization, and officers, employees, members, participants, users and/or volunteers, thereof, against any claim(s) arising out of said emergency care.

MEDICAL INFORMATON

This information is necessary so that we may provide you with appropriate medical support during your trip. This information is for the Honor Flight medical team only and will remain confidential. Your responses to these questions will not affect your eligibility. Please fill out this page completely. If something does not apply to you, please write N/A or NONE. Do not leave any questions blank.

TRAVEL COMPANION INFORMATION:

Honor Flight recognizes you may need assistance. You may bring one travel companion with you; however, there is a fee of $1,200 for a travel companion. The travel companion must be capable of handling all luggage and pushing your wheelchair, if needed. The travel companion must be aware of any medical conditions you may have. Honor Flight volunteers will be available to assist Veterans who need assistance and do not have a travel companion. The Honor Flight Network does NOT allow spouses or partners to go as a travel companion.