Menter / Adult Application

CONNECTICUT WATERFOWL ASSOCIATION
Waterfowl Mentoring Program

JUNIOR MEMBER AND ADULT NOVICE HUNTER APPLICATION

* Indicates required field

Name *

First

Last

Date of Birth *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

I certify that I have completed the Connecticut Conservation Education/Firearms Safety Course (or equivalent). My Certificate number is:

Certification # *

I understand that I must possess a Connecticut Small Game Firearms License prior to participating in waterfowl hunting and, if 16 years of age or older, possess a Connecticut and Federal Migratory Bird Conservation (“Duck Stamp”) Stamp. Also, I agree to sign a waiver and release agreement form that indemnifies the Connecticut Waterfowl Association and my mentor from any liability caused by negligent actions on my part. Parents and guardians should note that all youth hunters (< 18 years of age) must be accompanied by two adults. The adults can be two Mentors or one Mentor and the youth’s parent (or guardian) or another adult. Two Mentors can take two youths.

If under the age of 18 years, please have your parent or legal guardian fill out and sign the section below

I, am the parent or legal guardian, and I hereby give permission for him or her to hunt with whom I acknowledge meets the legal age, experience and licensing to function as a mentor for hunting.

Legal Guardian *

Junior Hunters Name *

Mentor Name *

Acknowledgement of Application

Signature: *

Date: *

Phone Number *

Submit

CONNECTICUT WATERFOWL ASSOCIATION Waterfowl Mentoring Program JUNIOR MEMBER AND ADULT NOVICE HUNTER APPLICATION

SITEMAP:

CONNECTICUT WATERFOWL ASSOCIATION
Waterfowl Mentoring Program

JUNIOR MEMBER AND ADULT NOVICE HUNTER APPLICATION