Veteran Application | Hudson Valley Honor Flight

Hudson Valley Honor Flight honors American veterans for your sacrifices and achievements by taking you to Washington, D.C. to see YOUR memorial at no cost. At this time, priority is given to WWII veterans and terminally ill veterans from all wars. For Honor Flight Network to achieve this goal, guardians fly with veterans on every flight providing assistance and helping veterans have a safe, memorable and rewarding experience. For what you and your comrades have given to us, please consider this a small token of appreciation on behalf of Hudson Valley Honor Flight. Effective May 7, 2025 a REAL ID will be required to fly within the United States. LEARN MORE

For further information, please contact us at 845-391-0076.

Veteran's Name *

First

Middle

Last

(Please list Your First, Middle & Last Name as it appears on your driver’s license or government ID.)

Nickname

Gender

Male
Female

*If other, please explain (provide dates).

Address *

City *

County *

State *

Zip Code *

Day Phone *

Evening Phone

Mobile Phone

Email Address *

Height *

Weight *

Date of Birth *

T-Shirt Size *

(S, M, L, XL, XXL, XXXL)

How did you hear about Hudson Valley Honor Flight?

Service History *

Branch of Service

Rank *

Years Active *

Emergency Contact

Emergency Contact Name #1 *

First

Last

(This person must be available in the local area the day you travel.)

Relationship *

Emergency Contact Day Phone *

Emergency Contact Evening Phone

Emergency Contact Mobile Phone

Emergency Contact #2

Emergency Contact Name #2 *

First

Last

(This person must be available in the local area the day you travel.)

Relationship *

Emergency Contact #2 Day Phone *

Emergency Contact #2 Evening Phone

Emergency Contact #2 Mobile Phone

Guardian

Do you have a Guardian who will be accompanying you on the flight?

If yes, please provide Name and Contact Number

First

Last

This person must submit a Guardian Application.

Guardian Day Phone

Guardian Evening Phone

Guardian Mobile Phone

PLEASE NOTE:
a. Spouses and significant others can NOT serve as your Guardian.
b. Please specify only ONE Guardian name.
c. All requested Guardians MUST fill out a Guardian application.
d. You do NOT have to provide your own Guardian – we have MANY volunteers signed up.

Transportation

Who will be providing your transportation to and from the rally point?

First

Last

Veterans MAY NOT drive themselves on Flight Day.

Driver #1 Phone

Driver #2 Name

First

Last

If needed.

Driver #2 Phone

Preferred Airport:

New York Stewart International Airport (Newburgh, NY)
Westchester County Airport (White Plains, NY)
No Preference

Medical Background

Do you use mobility equipment?

If YES, please indicate device:

Cane
Walker
Wheelchair

Also, if YES, will you be bringing your own equipment?

Do you take medication? What kind? How often?

Do you have any drug allergies?

If YES, please describe what type (i.e. grand mal, petit mal, other)

Do you have a history of seizure?

If within past 5 years, we STRONGLY recommend discussing this trip with your private physician.

Do you have problems with motion sickness (sea or air)?

If YES, is it controlled with medication?

If motion sickness is not controlled with medication, it is STRONGLY advised you discuss the trip with your private physician!

Do you have any breathing problems?

If YES, please describe:

Do you use a home nebulizer machine?

If YES, you are STRONGLY encouraged to discuss the trip with your private physician concerning the use of portable hand-held nebulizers during the trip.

Do you use oxygen at any time?

If YES, you will need your private physician to write a prescription for oxygen to be used during the flight and during the tour. The prescription should be turned in with the application.

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

If YES, please describe the reason (e.g. lung problems, arthritis, heart problems, etc.):

Do you have a history of open head injuries, sinus problems, or ear problems?

If YES, have you flown since the open head injury, sinus or ear problems occurred?

If YES, did you have any problems? Please describe.

If YES, it is STRONGLY advised that you discuss the trip with your private physician. If you have NEVER flown since the open head injury, sinus or ear problems, again we STRONGLY advise that you discuss the trip with your private physician.

Do you have a urostomy or colostomy bag?

If YES, please make sure the bag is vented prior to flight. If you do not know if your bag is vented, it is STRONGLY advised that you discuss this issue with your private physician.

Additional Comments or Concerns:

Please Review Carefully and Check Box Below:

The undersigned acknowledges and agrees that:

1. As photographic and video equipment are frequently used to memorialize and document Honor Flight trips and events, his/her 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 Honor Flight from all claims and liability relating to said photographs. 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 or compensation or ownership thereto.

2. I further state that medical insurance is the responsibility of the veteran and I understand that neither Honor Flight nor the provider of free private aircraft ("Flight Provider") provides medical care. I understand that I accept all risks associated with travel and other Honor Flight Network activities and will not hold Honor Flight, the Flight Provider, or any person appearing or quoted in any advertisement or public service announcement for or on behalf of Honor Flight responsible for any injuries incurred by me while participating in the Honor Flight program.

I agree to the above statements and wish to submit this information to Hudson Valley Honor Flight. *

I AGREE

Date / Time *

Date

Time

Please provide current date and time.

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