Application

Name (as appears on ID)*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth

Gender

Height

Weight

Phone

Branch of Service & Rank

Are you a post 2001 Veteran with a permanent, physical disability?*

Yes

To participate you must be a post 2001 Veteran with a permanent, physical disability.

Was your injury combat-related?*

Yes

Date of Injury*

Current Medications*

Injury/Disability & any mobility limitations: (Medical History)*

Current Passport?*

Yes

What is your closest MAJOR airport?*

Emergency contact / Name, Relation & Cell number:*

Dietary Restrictions / Allergies:*

Are you eligible to participate in VA programs and haven’t been debarred?*

Yes

Please tell us a little bit about yourself and describe your current fitnes level.*

What sports are you interested in:

Please upload a copy of your DD 214 (please blackout your SSN)

Accepted file types: jpg, png, jpeg, pdf, Max. file size: 5 MB.

A considerable amount of time, effort & money goes into this program to make it successful.
SUDS has ZERO tolerance for illegal drugs, alcohol abuse, sexual harassment, physical and/or emotional abuse. Also, the use of medical marijuana on a SUDS trip disqualifies your participation. Failure to follow these policies could result in your discharge from the program.
Filling out this application does not guarantee placement into the SUDS program.

Are you 100% committed to attend this program

Yes

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Phone

This field is for validation purposes and should be left unchanged.

SUDS Confidential Veteran Application