Veteran Application

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Application Date - Veteran

First Name *

Middle Name

Last Name *

Prefix

Suffix

Badge Nickname

Address Line 1 *

Address Line 2

City *

State/Province *

County *

Zip/Postal Code *

Country *

Phone 1 *

Phone 2

Email *

Gender *

Birth Date *

T-Shirt Size *

Weight *

Height

Data Privacy & Consent

Yes, I would like to receive text messages from First Coast Honor Flight for upcoming Events.

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Hometown

Branch of Service

Date of Service

Career Field/Units Assigned/Locations

If you would like to have a specifice relative or friend serve as your Guardian, please provide information below. Your spouse is not eligible. A child, relative or friend is welcome to apply as long as they are over 18 and are physically fit. They must submit a Guardian application. *

Guardian Name

Guardian Phone Number

Guardian Relationship

Email Address

If you wish to experience your trip to Washington, D.C. with a Veteran buddy, please list his/her name and phone number. Your Buddy must also submit an application and we suggest submitting your application together. Please fill out their name and phone number below *

Veteran Buddy Name

Veteran Buddy's Phone number

Veteran Buddy's Email Address

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Veteran Spouse Name *

Please enter n/a if not applicable

Veteran Spouse Street Address *

Please enter n/a if not applicable

Veteran Spouse City *

Please enter n/a if not applicable

Veteran Spouse State *

Please enter n/a if not applicable

Veteran Spouse Zip *

Please enter n/a if not applicable

Veteran Spouse Primary Phone *

Please enter n/a if not applicable

Veteran Spouse Cell Phone

Veteran Spouse Email Address *

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Veteran Emergency Contact Name *

Please enter n/a if not applicable

Veteran Emergency Contact Street Address

Veteran Emergency Contact City

Veteran Emergency Contact State

Veteran Emergency Contact Zip

Veteran Emergency Contact Relationship *

Veteran Emergency Contact Primary Phone *

Veteran Emergency Contact Cell Phone

Veteran Emergency Contact Email Address *

Please enter n/a if not applicable

Veteran Family - Non-Spouse Cell Phone

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Veteran Family - Non-Spouse Name *

Veteran Family - Non-Spouse Street Address

Veteran Family - Non-Spouse City

Veteran Family - Non-Spouse State

Veteran Family - Non-Spouse Zip

Veteran Family - Non-Spouse Relationship *

Veteran Family - Non-Spouse Primary Phone *

Veteran Family - Non-Spouse Email Address *

Please enter n/a if not applicable

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Veteran Friend, Neighbor, or Other Family Name *

Veteran Friend, Neighbor, or Other Family Relationship

Veteran Friend, Neighbor, or Other Family Street Address

Veteran Friend, Neighbor, or Other Family City

Veteran Friend, Neighbor, or Other Family State

Veteran Friend, Neighbor, or Other Family Zip

Veteran Friend, Neighbor, or Other Family Cell Phone

Veteran Friend, Neighbor, or Other Family Primary Phone *

Veteran Friend, Neighbor, or Other Family Email Address

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I state that the information provided in this application reflects a true and accurate summary of my personal status to the best of my ability.

I also state that I understand that personal medical insurance is my responsibility and I understand that First Coast Honor Flight (FCHF) does not provide medical care for me. I understand that I accept all risks associated with travel and other FCHF activities and will not hold FCHF staff and registered FCHF volunteers encountered during related activities responsible for any injuries or illness incurred by me while participating in the FCHF program. *

As a photographic, video, and audio equipment are frequently used to memorialize and document Honor Flight 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 Honor Flight program. I hereby release the videographer/photographer and FCHF from all claims and liability relating to said images. I hereby give permission for my images captured during Honor Flight activities through video, photo, or other media, to be used solely for the purposes of Honor Flight promotional material and publications, and waive any rights of compensation or ownership thereto. *

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Honoring our North East Florida Veterans with a trip of a lifetime.