Veteran Application Form – Honor Flight Kentucky

Click here (Veteran Form) to download a PDF, print, complete and mail form OR complete form below.

Please note: Do not use the return key until you have completed the entire application. Use your mouse cursor or the tab key to navigate between data entry fields.

If you are a human and are seeing this field, please leave it blank.

First Name

Middle Name

Last Name

Address

City

County

Zip Code

Daytime Phone

Cell Phone

T-Shirt Size

Date of Birth

Age

Spouse's Name

Spouse's Daytime Phone

Spouse's Cell Phone

Requested Flight Info (were you told to use a date or code for a flight? If so, enter that here. If not, leave blank):

Emergency Contact (someone who will be available day of travel)

Relationship to the Emergency Contact

Emergency Contact Daytime Phone

Emergency Contact Cell Phone

Please enter your branch of service

Please enter your rank

Please enter the year range of which you served in the military (in this format: 1955-1964)

What were your military duties?

Where were you stationed?

Were you awarded any medals?

Is there someone you want to go with you as your Guardian? (Please note: spouses are not allowed to serve as Guardians)

Do you use a wheelchair?

Do you use a cane?

Do you use a walker?

Can you walk up & down a set of eight bus steps with assistance?

Can you walk the length of a football field without assistance?

Do you have a history of seizures (please explain)?

Do you have problems with motion sickeness (please explain)?

Do you have a history of sinus or ear problems (please explain)?

Do you have breathing problems (please explain)?

Do you use bottled oxygen at any time (please explain)?

Do you use a home nebulizer machine?

Do you wear or have a heart pacemaker implanted?

Are you deaf or hard of hearing?

Have you been disgnosed with dementia or Alzheimer's disease?

Have you been diagnosed with diabetes? If so, how is it controlled?

Do you have urostormy, foley or a colostomy bag?

Are you legally blind?

Are you color blind?

What medications are you taking? (name, dosage and how often you take it)

Are you allergic to any drugs or foods ? Describe in detail

How did you hear about Honor Flight?