• Home
  • Tour
  • Application
  • Donate
  • Media
  • Contact

"*" indicates required fields

Step 1 of 7

14%

Veteran Application

Richland County Honor Trip is provided to each veteran at no cost. Top priority is given to our WWII veterans. A guardian will be provided to assist you on this three-day bus tour to Washington, D.C. This application places you on our list only. Seats on the bus are filled on a first-come, first, served basis. We will contact you regarding your application. We do not accept donations from the veterans participating in the trip prior to their trip.
Name*
As it appears on your ID
Address*

Spouses Information

Name

Emergency Contact

Son, daughter, etc. This is the contact for emergencies when you are on the trip.
Name
Address

Traveling with another Veteran?

If you would like to travel with another veteran, please provide their name below.
Name

Military Service

Years of Service, Decorations, War and Items of Special Interest.

Medical Information

The information provided will not disqualify you. It permits us to assess the support we need during the trip. Information is for Seneca County Honor Bus personnel only. Please note that you will be required to climb up and down short flights of steps to enter and exit the bus. Your physician must be aware of your planned participation of this three day trip.
I have motion sickness*

I have breathing problems*

I use a home nebulizer machine or CPAP*

I use Oxygen*

Diagnosed Alzheimer's?*

I use a colostomy or urostomy bag*

I am a diabetic*

I have a pacemaker*

Previous heart conditions*

I use a cane, walker, wheelchair*

History of Epilepsy or Seizures*

Can you walk the length of a football field?*

Do you sleepwalk?*

Do you wear depends or similar products?*

Other Medical Issues*

In lbs

Additional Medical Information

Drug and/or Food Allergies
Please list any drug and/or food allergies you may have
Allergy
 
I have checked with my Dr regarding this trip & time away*
Any other significant medical history we should know, including operations in the last two years?

Medication & Pharmacy Information


Medications
Medication Name
How Often
Dose & Time of Day
RX #
 

Review & Submit Application

As photographic and video equipment are frequently used to memorialize and document Richland County Honor Trip and events, my image may appear in a public forum, such as the media or website, to acknowledge, promote or advance the work of the Richland County Honor Trip program. I hereby release the photographer and Richland Country Honor Trip from all claims and liability relating to said photographs. I hereby give permission for my images captured during Richland Country Honor Trip activities through video, photo, or other media, to med used solely for the purpose of Richland County Honor Trip promotional materials and publications, and wave any rights or compensation or ownership thereto.
I understand and acknowledge that medical insurance is the responsibility of me, the veteran, and that Richland County Honor Trip does not provide medical care. I accept all risks associated with travel and other Richland County Honor Trip activities and will not hold Richland County Honor Trip responsible for any injuries incurred by me while participating in the Richland County Honor Trip.
I acknowledge that I have reviewed this application and that the information provided is true and accurate, Further, the undersigned does release and hold harmless Richland County Honor Trip, organization sponsors, committee members, agents successors and assigns from any and all actions, claims or damages for any personal injuries or property damages which may occur in the course of or during this trip or any of its activities.
I also attest that I have never been convicted of a felony nor under investigation for a felony offense.
MM slash DD slash YYYY
This application will be sent to:

AMVETS Post #26
1100 Fourth St.
Mansfield, OH 44906
ATTN: Richland County Veterans Honor Bus
419-565-3769

Contact Information

AMVETS Post #26
1100 Fourth St.

Mansfield, OH 44906
ATTN: Richland County Veterans Honor Bus

  • Follow

Accredited Charity

​The Richland County joint veterans council  is a 501(c)(3) nonprofit organization, The Richland County Honor Bus operates under that 501(c)(3).
© Richland County Honor Bus. All rights reserved.​

“We can’t all be heroes. Some of us have to stand on the curb and clap as they walk by.”

– Will Rogers

Navigation