Participant's Name
*
First Name
Last Name
Phone
(###)
###
####
Email
*
Participant's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Participant's Date of Birth
*
Participant's Age
*
Parent/Guardian Name
*
Will you require any special equipment in order to participate in this event?
*
Please describe your disability or special need/background.
*
If disability is from an accident, please include how it occurred.
How long have you been disabled/ill?
*
Wheelchair type: Electric or Manual?
*
Width of wheelchair at widest Point?
*
TOTAL Weight of Wheelchair and Participant?
*
If you answered yes above, please describe in detail, and advise if participant controls said behavioral issues with prescribed medications.
If you have any special adaptive equipment that you will bring, please describe.
*
Do you have a firearm/bow/rod&reel that you will bring to use?
*
Have you ever participated in a Hope Outdoors event? If so, please list chapter and date.
*
Describe any restricted diet you have:
Do you have ANY type of allergies? If so, please list.
What mode of transportation will you use to get to the event?
Describe any mobility and/or challenges:
Please list any special accomodations needed.
*
Please list any special medical attention that might be needed during an event:
*
List participant's religious affiliations, if any, including church membership and church contact information:
*
Any other information that would help us make your experience as meaningful as possible?
*
Shirt Size (ie: Youth Medium, Adult Large, etc.)
*
Please Read
By submitting this application for Hope Outdoors events the applicant and all parties involved agree that all information is true and correct and that Hope Outdoors has the permission to use the name of the applicant as well as photographic images or videos for the coordination and promotion of the event applied for. All parties involved agree that they take full responsibility for their decision to attend any Hope Outdoors event, regardless of the risk of exposure to illness, including but not limited to COVID-19.*
Has Participant ever fired a rifle or shotgun?
*
Has Participant ever harvested an animal?
*
