Site Logo

VetsRoll Assistant Application

(For Consideration as a VetsRoll Assistant)

VetsRoll, Inc®
2026 Assistant
Application

  • Assistant applications due by 6p, February 1, 2026
  • Medical team applications due by 6pm, January 1, 2026
  • First time assistants must be age 18-68 as of May 1, 2026

 Sunday, May 17th - Wednesday, May 20th, 2026

 Please send your completed application to:
 Mail:

 VetsRoll, Inc®
 1777 Gardner St
 South Beloit, IL 61080

Phone: 815-389-9630 (M-Sa)
Fax: 815-389-9631
E-mail:  applications@vetsroll.org

PLEASE NOTE: To be considered for the May 2025 trip, this form MUST be submitted, in entirety, NO later than Feb 1st, 2025!!

IMPORTANT NOTE: VetsRoll 2025 selections require a signed COVID Acknowledgement and Assumption of Risk Release

If selected, you must be present on registration day, Saturday, May 17th, 2025!


Please make sure you do not have popups disabled in your browser before you submit the form. It will prevent you from being directed to the successful submission page.

Your full name as it appears on your driver’s license or state ID:

Emergency Contact

In event of an emergency (medical or otherwise), we require emergency contact for each participant.

Signed Agreements Information and Resource Pages

All forms must be agreed to for consideration of participation of VetsRoll trip.
By checking the boxes, you are agreeing to terms and conditions and providing an electronic signature of applicant name on this form.

Covenent Not to Sue and Agreement to Hold Harmless Terms and Conditions

Covid Acknowledgement and Assumption of Risk Release

Assistant Expections

VetsRoll, Inc® Medical Information

Medical History

PLEASE NOTE: If you have experienced seizure activity within the past five years, we urge you to discuss this trip with your physician.

Do you have a friend who is an eligible Veteran, 'Rosie', or Assistant?

If you know an eligible Veteran, 'Rosie' or Assistant that you would like to travel with, please write their name and number belowand we will try, but cannot guarantee, to pair you together. Be sure they complete the appropriate application as well!

Remember, spouses are not eligile for the trip, unless they are also an eligible Veteran or 'Rosie-the-Riveter'

Medical Team Applicants Only

Tell Us About Yourself

Sell yourself. Why will you make a great assistant?