Oregon Department of Fish and Wildlife

Oregon Department of Fish and Wildlife Mentored Youth Hunter Program Registration Form

Please complete and return the top section of this form to: ODFW, Information and Education, Attn: MYHP, 4034 Fairview Industrial Dr. SE, Salem OR 97302.

Please note: Participants must submit a new form every year that they participate in the Mentored Youth Hunter Program. Youths only need to submit one form per year, no matter how many adult mentors they hunt with.

*Registration forms for the next calendar year will not be accepted until December of the current year.*

* PLEASE PRINT CLEARLY *

Date:

I am applying for (check only one): current year - OR - *next year

Youth's LAST Name:

FIRST Name:

Address:

City/State/Zip:

County:

Email:

Phone:(

)

Youth's Date of Birth (MM/DD/YYYY):

/

/

Gender: Male

Youth's ODFW ID# (if known, located on hunting or fishing license next to address):

To be completed by the supervising hunter:

What is the name of the supervising hunter who will accompany the youth on the initial hunt?

LAST Name:

FIRST Name:

What is the relationship of the supervising hunter to the youth?

Is this the youth's first hunting experience?

This top section to be sent to ODFW at the address listed above

Female

KEEP THIS BOTTOM SECTION ? Must be carried by Youth Hunter while hunting.

HUNT SAFELY ? HUNT RESPONSIBLY

Every hunter has the responsibility to enter the field well prepared to hunt in a safe, ethical manner; the future of our hunting heritage depends on it.

The Four Primary Rules of Firearm Safety

1. Muzzle ? Control the direction of your muzzle at all times. 2. Trigger ? Keep your finger outside of the trigger guard until ready to shoot. 3. Action ? Treat every firearm as though it were loaded ? Open the action and visually check if it is loaded. Firearms should be

unloaded with actions open when not actually in use. 4. Target ? Be sure of your target, and what is in front of it and beyond it.

I have reviewed the primary rules of firearm safety above and understand that I will be expected to follow these and all additional safety precautions as they are explained to me by the supervising hunter.

Youth Signature:

Date:

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