Internal Use Only: Last Name Date Received: Application Number: VOLUNTEER/ESCORT APPLICATION

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1 Internal Use Only: Last Name Date Received: Application Number: VOLUNTEER/ESCORT APPLICATION KILROY S KREW depends upon the efforts and support of our volunteers in whatever role they play, whether it is behind-the-scenes raising funds and organizing events, or whether they serve as Escort to a World War II veteran by physically assisting him or her from the time of departure until their return. An Escort is required to make a minimum donation of $500 to cover their costs (but contributions in larger amounts are very much appreciated). Wingmen will also need to attend a mandatory training session that will be held prior to the trip. KILROY S KREW cannot know how many Wingmen will be needed for any specific trip until we know how many veterans are scheduled for the trip. KILROY S KREW also needs volunteers to help raise funds, organize events, publicize our mission, create newsletters, etc. For further information, please contact us via kilroy@kilroyskrew.org or by phone at Please visit our website Contact Information: Name (as it appears on your driver s license or other photo ID -- THIS IS VERY IMPORTANT BECAUSE IF YOU ARE GOING TO FLY, THIS WILL BE USED FOR YOUR AIRLINE TICKET AND TSA MANDATES THAT YOUR TICKET AND ID MATCH): Nickname (if applicable): Address: City: State: Zip: Phone (Home): Phone (Cell): Date of birth: Age: Weight: Male Female Page 1 of 5

2 (Please Print Address Carefully) T-shirt size: S M L XL XXL XXXL What type of volunteer work are you interested in doing? Escort (to go on a trip to assist a World War II veteran) Coordinate an event (to promote Kilroy s Krew and raise funds) Give a presentation at an event (to promote Kilroy s Krew organization and raise funds) Help at an event Help with fundraising (making phone calls or calling on potential donors) Coordinate/help at send-off and/or welcome home Coordinate and maintain events calendar (must be internet savvy) Coordinate and maintain relationships with other organizations Serve as EMT/paramedic on trip Serve as medical information officer (review veteran applications for medical issues) Other areas of interest or ideas: Have you volunteered for non-profit work before? Yes No If yes, with what organization and what did you do? (please provide contact information for verification purposes) Page 2 of 5

3 Are you a veteran? Yes No If a veteran, please indicate which branch and when & where served: Why are you volunteering for Kilroy s Krew? Emergency Contact (Someone available by phone the day you travel) Name: Relationship: Address: City: State: Zip: Phone (Primary): Phone (Alternate): Please list one personal reference (someone not related to you who can speak to your character) Name: Relationship: Address: City: State: Zip: Phone (Primary): Phone (Alternate): Are you requesting to travel with a specific veteran? Yes No If yes, please list the veteran s full name and phone number. (Spouses may not serve as Wingmen.) Page 3 of 5

4 Are you able to push someone in a wheelchair for up to two hours? Yes No Are you able to lift 50 to 100 lbs? Yes No Please list any physical disabilities, restrictions and/or medical conditions that would limit your ability to perform the duties of an Escort. Also, please list any prescription medications you are currently taking: Do you smoke? Yes No (PLEASE NOTE THAT THERE IS NO SMOKING AT KILROY S KREW EVENTS AND THERE ARE NO OPPORTUNITIES FOR SMOKING ON THE TRIP.) Please list any medical education, certifications or experience you may have (e.g. EMT, CPR, Paramedic, etc.): Page 4 of 5

5 Please Review Carefully and Sign: The undersigned acknowledges and agrees that: 1) As photographic and video equipment are frequently used to memorialize and document trips and events, my image and name may appear in a public forum, such as the media or a website, to acknowledge, promote, or advance the work of KILROY S KREW (HEREINAFTER REFERRED TO AS KILROY S KREW ). I hereby release the photographer and KILROY S KREW from all claims and liability relating to said photographs. I hereby give permission for my name and my images captured during KILROY S KREW activities through video, photo, or other media, to be used solely for the purposes of KILROY S KREW 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. 2) I further state that medical insurance is my responsibility and I understand that KILROY S KREW does not provide medical care. I understand that I accept all risks associated with travel and other KILROY S KREW activities and will not hold KILROY S KREW responsible for any injuries incurred by me while participating in the KILROY S KREW program. COVENANT NOT TO SUE AND INDEMNITY AGREEMENT I,, am about to voluntarily participate as a passenger in various activities, including being transported by to Washington, DC by KILROY S KREW. 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 KILROY S KREW 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 KILROY S KREW. 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 KILROY S KREW 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 KILROY S KREW activities, including such injuries, death, damage, loss or destruction as may be caused by the negligence of KILROY S KREW. I also understand and agree that I may be held liable for any damages or loss to KILROY S KREW which is caused by my gross negligence, willful misconduct, dishonesty or fraud and for limited damages or loss to KILROY S KREW which is caused by my simple negligence. I further understand that the term KILROY S KREW includes any officer, agent and/or employee thereof. Signature: Date: Please print, sign / date, and submit this form to: KILROY S KREW Magnolia Arbor Lane Tomball, TX Or to: kilroy@kilroyskrew.org Page 5 of 5