Evacuee Intake Form/ Formulario de admisión de evacuados
Please complete all fields/ Por favor complete todos los campos.
**All passengers must be able to sit in airplane seat and walk onto and off the plane without medic assistance. There are no medical staff on board our flights. These flights are not air ambulances. / Todos los pasajeros deben poder sentarse en el asiento del avión y caminar hacia y desde el avión sin asistencia médica. No hay personal médico a bordo de nuestros vuelos. Estos vuelos no son ambulancias aéreas. **
Email address *
Full Legal Name *
Date of Birth *
Age *
Weight *
Passenger Cell Number *
Machine(s) to be used during flight (Model #) and confirmed FAA approval *
If companion, relationship to main passenger *
Preferred travel date, or ASAP *
Address in Puerto Rico *
Name of US Family/Friend *
Cell Number of US Contact *
Cell Number of US Contact *
Address in United States *
Name and contact number for person picking up upon arrival in States *
Special Flight Needs *
Safe to Fly note from Doctor *
Reason for contacting Warrior Angels
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