DarkeCounty Pheasants Forever

5th Annual Veteran Pheasant Hunt

November 12th 2017

Please complete and return this application to:

Attn:Daniel Francis

123 E. Star Rd

Rossburg, OH. 45380

PHONE 9375643254

*The first 60 Veterans who submit an application will be guaranteed a spot. *

***Everyeffort will be made to accommodate for any disabled Veterans.

Please contact us with any special needs. ***

Applications must be received by October 23rd.

Only Veterans whose application is accepted will receive a call verifying the hunt.

(Please print)

Name______Date of Birth ______

Address ______Phone # ______

______

Any special needs / addition information:

______

______

______

Registration Times

Registration will start at8:00 a.m. and MUST be completed by 12:00 noon

A group photo will be taken & raffle drawings will be held @ 12:00 noon.

If there are other veteran hunters you would like to hunt with please list up to three others. All others on the list will also have to mail in an application and be accepted to hunt. We will be hunting with groups of four, and every effort will be made to accommodate everyone the best we can. (Please print)

1. ______2.______

3. ______

Darke County

Veteran Pheasant Hunt Waiver

November 12th 2017

I understand that hunting is a sport involving firearms. Firearms, when mishandled, can be dangerous. Further, I understand that it is incumbent upon me to use the utmost care in the exercise of hunting safety and firearm safety. I intend to do so and realize that I have an affirmative duty to do so.

I further realize that Pheasants Forever, their members, agents, employees, licensees, volunteers, and associates are participating in this hunt to give me a quality outdoor experience. This participation by the referenced individuals may include travel to certain hunting areas. It will also include hunting with other individuals and with dogs. I understand that I must and will conduct myself in a manner so as to be safe around all of the individuals mentioned herein and their dogs.

Further, I waive all right to any claim, cause of action, right to litigation of any kind, whatsoever, originating from the November 12th Darke County Veteran Pheasant Hunt and thereafter for all time as to Pheasants Forever, the Darke County Chapter of Pheasants Forever, members, employees, volunteers, licensees of said organizations and their agents.

I realize that it is a privilege to participate in the Veteran Pheasant Hunt and accordingly I will conduct myself in a safe manner consistent with all affirmative duties I have heretofore recognized.

Participant ______