Empowered Dream Hunts Inc. Candidate Nomination Form
"Whitetail Hunts" for 2019 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?
Your answer
Has Candidate participated in the WI, 9 Day Disabled deer hunt program before? *
Name of Person Making Nomination *
Your answer
Nominator’s Phone Number(s) *
Your answer
Candidate Name *
Your answer
What is the age of the recipient *
Your answer
Candidate's Address *
Your answer
Parent(s) of Candidate (if under 18)
Your answer
Parent(s) of Candidate’s Address (if under 18)
Your answer
Parent or Candidate's Email Address
Your answer
Describe his/her condition/illness/special need/disability *
Your answer
Is he/she in need of any assistance, Please explain (Hunter must have someone to assist them *
Your answer
Has he/she taken a Hunter’s Safety Course *
Safety Course When? Where?
Your answer
How many years of hunting experience? *
Your answer
Has the candidate harvested a mature whitetail buck? *
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?
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.
Your answer
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 April 31st 2019
Electronic Signature of Candidate *
Your answer
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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