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Youth Mentor Hunt Application
Youth Hunter Details
Name
Address
Phone
Email
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.
What species are you interested in hunting (select all that apply)
Deer
Ducks
Geese
Pheasants
Turkey
Other
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.
Submit