Veterans Application

Please have your DD214 ready, you will need to submit it at the end of this form.

Spouses Information

Emergency Contact


Son, daughter, etc. This is the contact for emergencies when you are on the trip.
Traveling with another Veteran? If you would like to travel with another veteran, please provide their name below.

Military Service

Military Activity

Medical Information


The information provided will not disqualify you. It permits us to assess the support we need during the trip. Information is for 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.

Additional Medical Information


Drug and/or Food Allergies
Please list any drug and/or food allergies you may have

Additional Medical Information

Medication & Pharmacy Information

Medications

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.