Youth Mentor Hunt Application - Platte River Basin Environments

Youth Hunter Details

Name

Address

Phone

Date of Birth

Hunter Safety Card Number

Medical conditions or medications which the mentors need to be aware of:

Youth Hunter Request

Write a brief statement about your past hunting experience, if any, and what you would like to learn and experience from a Mentor Hunt Program.

Please list your after-school, evening, and weekend commitments (sports, church, scouts, work, etc.)

Parent or Guardian Release

Parent / Guardian Name

Parent / Guardian Phone Number

Parent / Guardian Email

Emergency contact if Parent/Guardian cannot be reached

Release Statement
I, the undersigned parent or guardian of the youth named in this application for participation in the Youth Mentor Hunt program assume full responsibility for risks associated with this activity. I recognize the activity may cause damage to property or injury or death to participants. I agree to hold harmless Platte River Basin Environments and the mentors involved in the program for any damages or bodily injury or death to the participants sustained in consequence of the aforesaid permitted activity not caused by their direct negligence.

e-Signature

Date

This is my e-signature and confirms my acceptance of the above release statement.