SFC Zenon Zacharyj presented the thanks of the US Army to the PLAV for donating Post 58's hall for training purposes. Shown accepting the award is Department of Ohio Treasurer Michael Polichuk.
28 February 2009
Department of Ohio Treasurer accepts thanks of US Army
SFC Zenon Zacharyj presented the thanks of the US Army to the PLAV for donating Post 58's hall for training purposes. Shown accepting the award is Department of Ohio Treasurer Michael Polichuk.
22 February 2009
Honor Flight Application
Veteran Application
Honor Flight recognizes American veterans for your sacrifices and achievements by flying you to Washington, DC to see YOUR memorial. no cost. Top priority (for which we are currently accepting application only) is given to WW2 and terminally ill veterans from all wars. In the future. Honor Flight will be expanded to include Korean and Vietnam veterans, hi order for Honor FIight to achieve this goal, guardians fly with the 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 from all of us at Honor Flight. For further information, please contact us a (937) 521-2400 or visit us at www.honorflight.org
YOUR NAME: ______________________________________NICK NAME:_____________
(As it appears on your ID for airline travel) (If Applicable)
ADDRESS: _____________________________________________________________________________________________
CITY: ___________________________________________________________________________ STATE: ______ ZIP: ________________
PHONE: Day: ___________________________________ Evening: ________________________ Cell Phone: _________________________
E-MAIL ADDRESS: WEIGHT: ________ AGE:_______
HOW DID YOU HEAR ABOUT HONOR FLIGHT?_______________________________________
___________________________________________________________________________ TEE SHIRT SIZE: S, M, L, XL, XXL, XXXL)_____
ALTERNATE CONTACT (son, daughter, etc): NAME:__________________________________________________________
PHONE:_____________________________ E-MAIL:_____________________________ RELATIONSHIP:______________
EMERGENCY CONTACT INFORMATION (someone available the day you travel):
Name: __________________________________________________________Relationship: ___________________________________________
Address: ________________________________________________________________________________________
PHONE: Day: ____________________ Evening: ________________________Mobile: ________________________
SERVICE HISTORY: BRANCH OF SERVICE: ___________________ RANK:_________________
HOME TOWN (from which city and state did you enter the service?):_____________________________________________
ACTIVITY DURING WWII: ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬_____________________________________________________________________________
______________________________________________________________________________________________________
MEDICAL: INFORMATION PROVIDED WILL NOT DISQUALFY YOU. IT Permits US TO ASSESS THE
SUPPORT WE NEED DURING THE TRIP. INFO IS FOR HONOR FLIGHT AND MEDICAL PERSONNEL ONLY.
Do you use mobility equipment? YES NO. If YES, please circle device: CANE WALKER WHEELCHAIR SCOOTER
MEDICATIONS (name and how often you take it):
MEDICATION TAKEN HOW OFTEN? MEDICATION TAKEN HOW OFTEN?
_______________ ____________________ _______________ _______________
_______________ ____________________ _______________ _______________
_______________ ____________________ _______________ ________________
Do you have any drug allergies? ________________________________________________________________________
Do you have a history of seizure? YES NO Please describe what type (i.e. grand mal, petit mal, other) ________________
When was your last seizure? ________. If within past 5 years, STRONGLY advised you discuss trip with your private physician!
Do you have problems with motion sickness ass (sea or air)? YES NO. If yes, is it connected with medications? YES NO. If motion sickness is not
controlled with medications, it is STRONGLY advised you discuss the trip with your private physician!
Do you have any breathing problems? YES NO. If YES, please describe: _____________________________ ______________________________
Do you use a home nebulizer machine? YES NO. 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? YES NO. If YES, you will need your private physician to write a prescription for oxygen to be used during the flight and during the tour. Oxygen will be provided. The prescription should be turned in with the application.
Do you have a problem walking the length of a football field without assistance? YES NO. 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? YES NO. If YES, have you flown since the open head injury, sinus or ear problems occurred? YES NO. If YES, did you have any problems? YES NO. If YES, it is STRONGLY advised 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 you discuss the trip with your private physician.
Do you have a urostomy or colostomy bag? YES NO. 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 CAREFULLYAND SIGN:
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 Honor Flight does NOT provide medical care. I understand that I accept all risks associated with travel and other Honor Flight activities and will not hold Honor Flight responsible for any injuries incurred by me while participating in the Honor Flight program
SIGNED: _________________________________________________________________________________________________
DATE: ______/_____/_____ (E-mail applicants will, be required to sign prior to actual flight date)
Please submit this form to: Honor Flight, Inc.
ATTN: Veteran Application
300 Auburn Ave.
Springfield, 0H 45505-4703
Or e-mail to: veteran-application@honorflight.org
Or fax to: (937) 521-2580 or (937) 864-0524
Honor Flight recognizes American veterans for your sacrifices and achievements by flying you to Washington, DC to see YOUR memorial. no cost. Top priority (for which we are currently accepting application only) is given to WW2 and terminally ill veterans from all wars. In the future. Honor Flight will be expanded to include Korean and Vietnam veterans, hi order for Honor FIight to achieve this goal, guardians fly with the 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 from all of us at Honor Flight. For further information, please contact us a (937) 521-2400 or visit us at www.honorflight.org
YOUR NAME: ______________________________________NICK NAME:_____________
(As it appears on your ID for airline travel) (If Applicable)
ADDRESS: _____________________________________________________________________________________________
CITY: ___________________________________________________________________________ STATE: ______ ZIP: ________________
PHONE: Day: ___________________________________ Evening: ________________________ Cell Phone: _________________________
E-MAIL ADDRESS: WEIGHT: ________ AGE:_______
HOW DID YOU HEAR ABOUT HONOR FLIGHT?_______________________________________
___________________________________________________________________________ TEE SHIRT SIZE: S, M, L, XL, XXL, XXXL)_____
ALTERNATE CONTACT (son, daughter, etc): NAME:__________________________________________________________
PHONE:_____________________________ E-MAIL:_____________________________ RELATIONSHIP:______________
EMERGENCY CONTACT INFORMATION (someone available the day you travel):
Name: __________________________________________________________Relationship: ___________________________________________
Address: ________________________________________________________________________________________
PHONE: Day: ____________________ Evening: ________________________Mobile: ________________________
SERVICE HISTORY: BRANCH OF SERVICE: ___________________ RANK:_________________
HOME TOWN (from which city and state did you enter the service?):_____________________________________________
ACTIVITY DURING WWII: ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬_____________________________________________________________________________
______________________________________________________________________________________________________
MEDICAL: INFORMATION PROVIDED WILL NOT DISQUALFY YOU. IT Permits US TO ASSESS THE
SUPPORT WE NEED DURING THE TRIP. INFO IS FOR HONOR FLIGHT AND MEDICAL PERSONNEL ONLY.
Do you use mobility equipment? YES NO. If YES, please circle device: CANE WALKER WHEELCHAIR SCOOTER
MEDICATIONS (name and how often you take it):
MEDICATION TAKEN HOW OFTEN? MEDICATION TAKEN HOW OFTEN?
_______________ ____________________ _______________ _______________
_______________ ____________________ _______________ _______________
_______________ ____________________ _______________ ________________
Do you have any drug allergies? ________________________________________________________________________
Do you have a history of seizure? YES NO Please describe what type (i.e. grand mal, petit mal, other) ________________
When was your last seizure? ________. If within past 5 years, STRONGLY advised you discuss trip with your private physician!
Do you have problems with motion sickness ass (sea or air)? YES NO. If yes, is it connected with medications? YES NO. If motion sickness is not
controlled with medications, it is STRONGLY advised you discuss the trip with your private physician!
Do you have any breathing problems? YES NO. If YES, please describe: _____________________________ ______________________________
Do you use a home nebulizer machine? YES NO. 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? YES NO. If YES, you will need your private physician to write a prescription for oxygen to be used during the flight and during the tour. Oxygen will be provided. The prescription should be turned in with the application.
Do you have a problem walking the length of a football field without assistance? YES NO. 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? YES NO. If YES, have you flown since the open head injury, sinus or ear problems occurred? YES NO. If YES, did you have any problems? YES NO. If YES, it is STRONGLY advised 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 you discuss the trip with your private physician.
Do you have a urostomy or colostomy bag? YES NO. 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 CAREFULLYAND SIGN:
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 Honor Flight does NOT provide medical care. I understand that I accept all risks associated with travel and other Honor Flight activities and will not hold Honor Flight responsible for any injuries incurred by me while participating in the Honor Flight program
SIGNED: _________________________________________________________________________________________________
DATE: ______/_____/_____ (E-mail applicants will, be required to sign prior to actual flight date)
Please submit this form to: Honor Flight, Inc.
ATTN: Veteran Application
300 Auburn Ave.
Springfield, 0H 45505-4703
Or e-mail to: veteran-application@honorflight.org
Or fax to: (937) 521-2580 or (937) 864-0524
06 February 2009
Video honoring Post #30's Richard T.Borkowski, JVCCC 2008 Outstanding Veteran of the Year
For those of you who couldn't be there, click on the text in the paragraph above.
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