JavaScript must be enabled for online registration.
Guardian Information
First Name
Middle Name
Last Name
Nickname
(if used)
Date of Birth
Month
Jan.
Feb.
Mar.
Apr.
May
June
July
Aug.
Sept.
Oct.
Nov.
Dec.
Gender
Male
Female
Contact Information
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Zipcode
County
Daytime Phone
Evening Phone
Mobile Phone
Email Address
Service History
Are you a Veteran?
Yes
No
Branch of Service (check all that apply)
Army
Navy
Air Force
Marines
Coast Guard
Other
Service Dates / Comments:
Emergency Contact
The Emergency Contact should be someone available on the day of the trip.
First Name
Last Name
Relationship
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Zipcode
Daytime Phone
Evening Phone
Mobile Phone
Email Address
Medical Information
What is your Weight?
What is your Height?
Medications
Do you have any drug allergies?
Yes
No
Please describe your drug allergies:
Do you have any food allergies?
Yes
No
Please describe your food allergies:
Do you have a history of seizures?
Yes
No
Please describe what type of seizures:
When was your last seizure?
Are you claustrophobic?
Yes
No
Are you visually impaired?
Yes
No
Are you deaf or hard of hearing?
Yes
No
Do you have a urostomy, colostomy, or urinary catheter?
Yes
No
Please describe:
Do you use insulin?
Yes
No
How is your Diabetes controlled? (Insulin or Pills)
Do you wear or have a heart pacemaker implanted?
Yes
No
Do you have any condition(s) (not mentioned above) or circumstances which might limit your ability to travel with a commercial airline, or could limit your ability to physically participate in this event?
Do you require a special meal?
Yes
No
Please describe special meal:
Additional Information
T-Shirt Size
S
M
L
XL
XXL
XXXL
XXXXL
Other
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
Veteran's First Name
Veteran's Middle Name
Veteran's Last Name
Occupation:
Please list any prior Volunteer experience:
Remarks / Comments:
How did you hear about Honor Flight?
Additional Questions
By submitting this application, I acknowledge and agree to the Kansas Honor Flight photography and insurance requirements.:
Yes
No
Submit Application