Nevada Outdoorsmen in Wheelchairs

Nevada Outdoorsmen in Wheelchairs

Hunt Application
Any information obtained through this application is considered confidential and is solely to be used by Nevada Outdoorsmen in Wheelchairs for the evaluation of hunt candidates.

This is only an application, and does not guarantee a granted hunt.

If you have questions, please feel free to contact us.
Date:

MonthDayYear
Applicant's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number

Area CodePhone Number
Birth Date

MonthDayYear
Clothing Sizes:

Optional - We often get donations of supplies for the hunter.
Shirt
Pant (W x L)
Shoe
Coat
Height
Weight
Chaperone / Assistant

I understand that if chosen for a NOW hunt, I will have one chaperone/assistant with me.
Chaperone/Assistant Name

First NameLast Name
Relationship to Applicant
Experience:
Does Applicant have a hunter certification card?
Has the applicant ever been hunting before?
If Yes, please explain hunting experience:
Has the applicant ever fired a gun?
If yes, what caliber and brand?
Medical History and Condition:
Please give us a brief history of what brought the applicant to be confined in a wheelchair:
Please identify ANY physical and / or mental limitations, as well as other medical concerns that may be a factor in this NOW hunt:
Is the applicant on any current therapy or treatment?
If Yes, please explain:
If this applicant is selected to be a recipient of a NOW hunt, please list any special equipment (gun rest, adaptive equipment, etc.) that may be necessary:
Please note that all areas of this application must be completed in full in order for it to be submitted to the board for approval. A letter from your personal physician or hospital supporting the assessment of the applicant's condition should be mailed to us to accompany your submitted application. An additional letter will be required within one month of the hunt.

Incomplete applications will not be accepted!

Mail Physician's letter to: NV Outdoorsmen in Wheelchairs, PO Box 794, Virginia City, NV 89440
Should be Empty:

Nevada Outdoorsmen in Wheelchairs

Clothing Sizes:

Chaperone / Assistant

Experience:

Medical History and Condition: