Central and Southwest Virginia Honor Flight (CSWVAHF) recognizes area veterans by taking all who are able on an overnight charter bus day trip to Washington D.C. to visit the memorials built to honor their sacrifice and service at no cost to them.

Space is limited and applications for WWII and terminally ill veterans are processed on a first come first served basis (all others are considered on a space available basis). If you are unable to make the trip on the next scheduled date, you may request to be continued on the list for the next trip.For what you and your band of brothers and sisters have given, please consider this a small token of appreciation. Please submit you application as early as possible!

For further information, please contact us via e-mail at cswvirginiahonorflight@gmail.com or by phone at 540-589-0014.

Name *
Name
As It Appears on Your ID
Address *
Address
Mailing Address
Primary Phone *
Primary Phone
Cell Phone
Cell Phone
Date of Birth *
Date of Birth
Service Era *
Emergency Contact Information
For your emergency contact, choose someone who will be available by phone during the trip (Friday to Sunday. Preferably this would be a family member or friend that we could contact before the trip as well.
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Address *
Emergency Contact Address
Emergency Contact Primary Phone *
Emergency Contact Primary Phone
Medical Information
Information provided will not disqualify you. It permits us to assess the support we need to provide during the trip. Information is for Central and Southwest Virginia Honor Flight and volunteer medical personnel only.
List any drug allergies you may have below.
Please list the names of the prescription medications you take below.
If so, check all that apply:
Selecting "No" means that you will require a wheelchair lift.
i.e. lung problems, arthritis, heart problems, etc.
i.e. diet, oral medication, insulin, etc.
Note: If your last seizure was within the last five years, we STRONGLY advise you to discuss this trip with your private physician.
If yes, please select what best describes your seizure(s)?
Note: If motion sickness, is not controlled with medication, we suggest you discuss this trip with you private physician.
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.
If yes, you must provide us a written copy of your prescription for oxygen and you must bring your own oxygen to be used during two days of the trip (Friday and Sunday). Central and Southwest Virginia Honor Flight requires a copy of the prescription in case of emergency.
Potential Guardian Information
With all honor flight trips, each veteran is assigned a guardian to accompany them throughout the trip. Every effort will be made to comply with your request but we cannot guarantee this will happen. Spouses of veterans cannot be their guardian, but other family members will be considered. The requested guardian must be capable of performing the requirements for a guardian (as listed in the guardian application), submit a guardian application, agree to make the minimum $400 donation to cover his/her expenses and attend a mandatory training.
Potential Guardian Name
Potential Guardian Name
Potential Guardian Primary Phone Number
Potential Guardian Primary Phone Number
Potential Guardian Cell Phone Number
Potential Guardian Cell Phone Number
Please Review Carefully and Sign
Photo/Video Release *
As photographic and video equipment are frequently used to memorialize and document Central and Southwest Virginia Honor Flight trips and events, my image and name may appear in a public forum, such as the media or a website, to acknowledge and promote, or advance the work of the Central and Southwest Virginia Honor Flight program. I hereby release the photographer, videographer, and Central and Southwest Virginia Honor Flight from all claims and liability relating to said photographs and video footage. I hereby give permission for my name and my images captured during Central and Southwest Virginia Honor Flight activities through video, photo, or other media, to be used solely for the purposes of Central and Southwest Virginia Honor Flight promotional material and publications and waive any rights of compensation or ownership thereto. Media coverage is the best way for us to promote the program to other veterans. This coverage may include the names of participants. I hereby release the use of my name for this purpose unless I provide written restriction before the trip.
Medical Release *
I further state that medical insurance is my responsibility and I understand that Central and Southwest Virginia Honor Flight does not provide medical care. I understand that I accept all risks associated with travel and other Central and Southwest Virginia Honor Flight activities and will not hold Central and Southwest Virginia Honor Flight responsible for any injuries incurred by me while participating in the Central and Southwest Virginia Honor Flight program.
Agreement to Not Consume Alcohol on Trip: *
I understand that alcohol consumption is not allowed on any Honor Flight organization trips. By signing this agreement, I agree to refrain from alcoholic beverages while voluntarily participating in a Central and Southwest Virginia Honor Flight trip.
Covenant Not to Sue and Indemnity Agreement *
I am about to voluntarily participate as a passenger in various activities, including being transported by bus to Washington, DC by Central and Southwest Virginia Honor Flight, Inc. In consideration of this organization permitting me to participate in these 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 in the institution or prosecution of any demand, claim or suit against the organization known as Central and Southwest Virginia Honor Flight, Inc. 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 Central and Southwest Virginia Honor Flight, Inc. organization. If I, my heirs, administrators, executors or assigns should demand, claim, sue or aid in any way in such a demand, claim or suit, I agree, for myself, my heirs, administrators, executors, and assigns to indemnify the Central and Southwest Virginia Honor Flight, Inc. 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 Central and Southwest Virginia Honor Flight, Inc. activities, including such injuries, death, damage, loss or destruction as may be caused by the negligence of the Central and Southwest Virginia Honor Flight, Inc. organization. I also understand and agree that I may be held liable for any damages or loss to the Central and Southwest Virginia Honor Flight, Inc. organization which is caused by my gross negligence, willful misconduct, dishonesty or fraud and for limited damages or loss to the Central and Southwest Virginia Honor Flight, Inc. organization which is caused by my simple negligence. I further understand that the term Central and Southwest Virginia Honor Flight, Inc. organization includes the national non-profit organization known as Honor Flight, Inc., any officer, agent and/or employee thereof.