Hunter Application Starke County Hunt "*" indicates required fields 1Hunter Information2Waiver of Liability Please Note: Application must be returned by March 15th. All accommodations will be provided for the hunter and family, including meals, motel and license for hunter. Due to the expense, if you need to cancel please notify Carol Corey NO LATER THAN April 1st. The number to call is 574-806-3310. Name of Hunter* First Last Parent('s) Names*Phone*Email* What is your disability or illness?*Are you willing to sign a waiver of responsibility?* YES NO What is your shirt size?* SM MED LARGE XL XXL XXXL Other Do you need a motel room if hunting in your chosen area?* YES NO Do you need shooting equipment to hold your gun?* YES NO Do you have hunting experience?* YES NO Do you use a wheelchair?* YES NO Motorized or Manual?* Motorized Manual NOTES / Do you need special equipment?****NOTE:*** If you filled for an apprentice licenses for 3 hunting licenses, you must take a Hunters Safety Course and obtain a Hunter Safety Card before you will be able to hunt in Indiana.Hunter License InformationPlease fill out the below information for your Hunting Licenses.Hunter Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have you taken the Hunter Safety Course?* YES NO Hunter Safety Course Number*Hunter Social Security Number**Maximum of 9 digits. County of Residence*Birthday* MM slash DD slash YYYY Age of Hunter*Hair Color*Eye Color*Height*Weight****If You have a lifetime license, please submit your number here: Waiver of Liability*AMERICANS WITH DISABILITY ACT 1990, Turkey Tracks Hunt Eric Corey Foundation prohibits discrimination against disabled people and guarantees equality of opportunity for people with disability as well as terminally ill for hunting adventures. WAIVER OF LIABILITY, Turkey Tracks Hunt Eric Corey Foundation is a non-profit organization seeking to grant wishes for disable and critical-ill individuals seeking to participate in a major hunting expedition. To that end, Turkey Tracks Hunt Eric Corey Foundation requires the execution of this comprehensive waiver as follows: The undersigned agree that he/she, along with his/her successors, heirs and assigns to hold harmless and forever indemnify Turkey Tracks Hunt Eric Corey Foundation, its Board of Directors, agents and collaborators from liability associated with any death or injury resulting from. Or in association with, or during the execution of the event as set forth and otherwise facilitated by Turkey Tracks Hunt Eric Corey Foundation. The undersigned also agree the he/she, along with his/her successors, heirs and assigns to hold harmless and forever indemnify of the person or persons offering the hunting expedition, namely the Donor, its agents and collaborators from any and all liability associated with any injuries sustained in association with, or during the execution of the event as set forth and otherwise facilitated by the Donor and Turkey Tracks Hunt Eric Corey Foundation. This instrument shall be applicable to any accident, injury, or event that accrues in 2015 or succeeding years. The undersigned personally accepts all liability and responsibility for the action of everyone hunting with him or her (including minors, friends, associates, guest, etc). This agreement also gives Turkey Tracks Hunt Eric Corey Foundation the legal right to use any pictures or video/audio recording taken for advertisement (which includes magazine, newspaper, website, brochures, television broadcasts, etc) with the purpose only being to help encourage others to participate in enjoying the great outdoors. (NOTE: Donor listed in the Waiver of Liability is the one donating the outdoor adventures). THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further states that no oral representations, statement, or inducements apart from this agreement have been made. I have read the above Waiver of Liability.Date*Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Signature*Parent Signature(if you are a minor)CommentsThis field is for validation purposes and should be left unchanged.
