DIVISION OF WILDLIFE
Ohio Department of Natural Resources
FIELD TRIAL AND FACILITY APPLICATION AND PERMITS
Submit to the appropriate District Wildlife Office (see guidelines). Application
must be postmarked at least 30 days prior to the field trial or use of the facility.
FIELD TRIAL APPLICATION (check & complete the appropriate section below): PERMIT NO.______
□ Non-shooting field trial on state-owned or controlled land ($50.00/day) (these items will be in a box below)
Name of wildlife area or other state-owned or controlled land, including AEP agreement lands
YearMonthDate(s)
□ Shoot-to-kill field trial on state-owned or controlled land ($50.00/day) (these items will be in a box below)
Name of wildlife area or other state-owned or controlled land
YearMonthDate(s)
□ Shoot-to-kill field trial on privately-owned land ($50.00/day) (these items will be in a box below)
CountyName of area where trial will be held
Year MonthDate(s)
Species of game bird to be released: ______Number released:______
Name of licensed propagator supplying game birds: ______
□ Check if the club wishes to ride horses on a state-owned or controlled field trial area prior to the event in order to lay out and review the course. This will be permitted only on the Tuesday-Friday immediately preceding the event. A maximum of 5 horses is permitted for this purpose. The Wildlife Area Manager should be contacted before entering the field trial area.
Total amount enclosed for field trial: $______. Payable to: Ohio Division of Wildlife
Full payment for the field trial must be submitted with the application. Applications received without payment will not be processed nor will the requested dates be reserved.
Name of field trial club: ______
Name of club representative: ______
Club representative’s mailing address & telephone number:______
______
I certify that this application is made in good faith and that the trial will be conducted in accordance with the Ohio Revised Code, Ohio Administrative Code, and the conditions of this permit.
I acknowledge that a report must be submitted to the District Office within 30 days after the field trial summarizing the event (see field trial guidelines for report requirements).
______
Signature of club representativeDate
Approved: ______
District Manager or representative Date
Cc: District WM Supervisor, WA Manager, Wildlife Officer, Applicant
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FACILITY APPLICATION AND PERMIT
This portion of the application only needs to be completed by field trial clubs wishing to use the facilities at Tri-Valley Wildlife Area. Payment for use of these facilities must be submitted with the field trial permit application. Applications received without payment will not be processed nor will requested dates be reserved.
Daily fees:
Tri-Valley Wildlife Area:
Facilities for field trial activities (a field trial permit is also required)…….…$185.00 x ____ days =______
(includes the service center, horse corral, dog kennel, & parking area)
Note: Any use of the facility including the parking area before or after the field trial event must be included in this permit and paid for. Two weekend days = 4pm Friday to sunset on Sunday.
Date(s) of use: ______
Total amount enclosed for facility use: $______. Payable to: Ohio Division of Wildlife
This application is made in good faith. The event for which the facility will be used will be conducted in accordance with the Ohio Revised Code, Ohio Administrative Code, and the conditions of this permit.
______
Signature of club representative Date
Approved: ______
District Manager or representative Date
Additional conditions that apply to the _____ Field Trial and/or _____ Tri-Valley WA Facility Permit (check one or both) are as follows:
Cc: District WM Supervisor, WA Manager, Wildlife Officer, Applicant