The purpose of this form is to provide medical information about the participants should an emergency arise. The Medical Form is completed by all Veterans, Guardians and Flight Crew prior to participating in a Stars and Stripes Honor Flight.

By completing the following information, I hereby authorize Stars and Stripes Honor Flight Inc, its officers, employees, members, participants, users and/or volunteers, to take the action they believe is appropriate in an emergency situation. Further, I agree to indemnify and hold harmless the Stars and Stripes Honor Flight, Inc, and officer, employee, member, participant, user and/or volunteer thereof, against any claim(s) arising out of said emergency care.

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