Empowered Dream Hunts Inc. Candidate Nomination Form
"Whitetail Hunts" for 2021 season
Was the candidate in the military or Law Enforcement? *
Has the candidate applied with Empowered Dream Hunts Inc before? *
If the candidate did go on a Dream hunt with us did you get a deer? *
Has Candidate participated on a Disabled deer hunt? *
When? Where? What did they shoot?
Has Candidate participated in the WI, 9 Day Disabled deer hunt program before? *
Name of Person Making Nomination *
Nominator’s Phone Number(s) *
Candidate Name *
What is the age of the recipient *
Candidate's Address: Address & City *
Parent(s) of Candidate (if under 18)
Parent(s) of Candidate’s Address (if under 18)
Parent or Candidate's Email Address
Describe his/her condition/illness/special need/disability *
Is he/she in need of any assistance, Please explain (Hunter must have someone to assist them *
Has he/she taken a Hunter’s Safety Course *
Safety Course When? Where?
How many years of hunting experience? *
Has the candidate harvested a mature whitetail buck? *
If candidate harvested a whitetail buck please explain what you harvested
Has candidate ever been convicted of a criminal offense? *
Does candidate have any criminal charges against you? *
Has candidate entered into a pretrial diversion or similar program relating to any criminal offense *
Is candidate restricted from possessing or using firearms or weapons for any reason? *
Has candidate been diagnosed with a mental illness? *
Has candidate ever been convicted of a fish or game violation? *
Does the candidate have hunting land to hunt on?
Clear selection
If candidate does have land and harvested a deer please explain what you harvested
I understand that Empowered Dream Hunts Inc. may do any or all of the following to determine my eligibility to participate in the Whitetail Hunt, and I hereby consent to the same: 1. Investigate all statements contained in this application. 2. Conduct a criminal background check. I certify that the answers and information given in this application are true and correct to the best of my knowledge. I agree that false or misleading information given in my application may disqualify me from consideration.
Hunter must have someone come along on the hunt, and may stay more than one day. By signing this waiver you allow Empowered Dream Hunts Inc. to use your images for advertising. If you do not get picked this year, you must reapply next year. Deadline July 31st 2021
Electronic Signature of Candidate *
For more information, please call Joe or Laurie Ramsey at 715-693-3322 or 920-290-2108. Please send thisapplication to: Empowered Dream Hunts Inc. 526 Sandy Lane, Mosinee, WI 54455 or e-mailPlease visit us on our website or Face Book page: www.empowereddreamhuntsinc.org
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