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Participant Qualifications

U.S. Military Service Member injured as a direct result of enemy combatant actions.
Allied Military Service Member injured as a direct result of enemy combatant actions while in support of a U.S. operation.
U.S. Citizen Security Consultant injured as a direct result of enemy combatant actions while working under contract with a U.S. agency (CIA, State Department, Department of Defense, etc.) and while in support of a U.S. operation.
Service Member approved for disability from the VA for combat-related PTSD.

We welcome all applications. Priority is given to Purple Heart recipients and Veterans injured during combat deployments. After priority applicants have been admitted, remaining spaces will be made available to other Veterans.

WS4WW WARRIOR APPLICATION FORM

Contact Information

First Name

Last Name

Phone

Street Address

City

State

Zip

Country

Insurance

Provider

Policy Holder Name

Member ID

Emergency Contact

Name

Phone Number

Medical (not required but helpful in an emergency)

Do you have any known allergies?

Do you have any metal in your body? (implants, plates, screws, shrapnel)

Do you have any implanted medical devices? (pacemaker, insulin pump, etc.)

Are you pregnant or possibly pregnant?

Do you have a history of seizures or fainting?

Demographics

Gender

Date Of Birth

Measurements

Waist Size(in)

Chest Size(in)

Shorts Size(s/m/l)

Shoe Size

T-Shirt Size

Weight

Height

Service Details

Service

Documentation

Nature Of Injury

Event Leading To Injury

Additional Notes/Comments (service animals, physical restrictions, mental health, etc.)

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