REGISTRATION FORM LEARN TO HUNT TURKEY PROGRAM Sponsors: Wisconsin DNR, Door County Fish Farm and Game Club Inc., and the Gardner Rifle Club Mandatory classroom session: March 28, 2015 CONTACT DICK BAUDHUIN 920 743 2581 OR 920 743 2581 Days of the Hunt: 4/4/15 THROUGH 4/12/15 EMAIL [email protected] PLEASE PRINT NAME ____________________________________________________________________________ ADDRESS__________________________________________________________________________ CITY_________________________________________STATE_____________ZIP_________________ BIRTHDATE_________________________AGE____________________(must be at least 10 years) DNR customer number_____________________________(REQUIRED) Hunter Education Certificate Number___________________________________(if you have one) *If the applicant does not currently have a customer number, please call the DNR Call Center at 1-888-936-7463 to obtain one. You will need to provide the student’s name, address, date of birth, and Social Security Number. Confidential Information will not be released.

Please circle your answers to the following questions: Do you have a shotgun to use: YES NO 12ga_____ 20ga_____ Have you ever turkey hunted: YES NO Have you applied for a turkey permit: YES NO Do your parents hunt: YES NO Do your parents hunt turkey: YES NO Do your grandparents hunt: YES NO Do your grandparents hunt turkey: YES NO PERMISSION SLIP I request to participate in this LEARN TO HUNT TURKEY PROGRAM sponsored by the Door County Fish, Farm and Game Club, Inc. and the Wisconsin DNR. I agree to obey the orders of the mentors and instructors and will conduct myself in a respectful manner using care and safety at all times. I hereby hold the sponsors harmless for any accident, injury, or malady which might occur as a result of the activities involved with the LEARN TO HUNT PROGRAM. Signature____________________________________________ Date_________________________ IF YOUTH UNDER 18 YEARS OF AGE: I/we, the parent(s) or legal guardian(s) of the above minor, hereby consent to said minor’s participation in this LEARN TO HUNT TURKEY PROGRAM, and hereby hold the sponsors harmless for any accident, injury or malady which might occur as a result of the activities involved with this program. I understand hunting will be with an authorized mentor. I/we give permission to the leaders/mentors of the LEARN TO HUNT TURKEY PROGRAM to render first aid should the need arise. In the event of an emergency, I also give permission to the physician, selected by the adult leader in charge, to hospitalize, secure proper anesthesia, order injection or secure other medical treatment, as needed. I give permission to use digital or video images of my child in written publications or on the web promoting Learn to Hunt Events. I understand the mentor will keep the carcass tag if the hunt is unsuccessful. Mandatory tagging with the issued carcass tag and registration (1-888-HUNT WIS) Parent/Guardian Signature______________________________ Date____________________ Parent/Guardian contact number____________________________ If I cannot be reached, please contact ______________________________ at _____________________