Northern Nevada Outfitters | Medical Application

1. Personal Information

Full Name

Date of Birth

Age

Gender

Male

Female

Other

Address

City

State

ZIP Code

Phone Number

Email Address

3. Cancer Diagnosis and Treatment Information

Type of Cancer

Current Status

Under Treatment

In Remission

Other

Date of Diagnosis

Are you currently receiving treatment?

Yes

Physician Name and Contact Information

Are there any physical limitations due to your condition/treatment?

Yes

Do you require any accommodations or assistance during the trip?

Yes

4. Medical Information

Do you have any allergies (e.g., food, medication, insect bites)?

Yes

Do you have any medical devices (e.g., oxygen, mobility aids)?

Yes

Are you able to walk or navigate outdoor terrain?

Yes

* All applicants will need to provide documentation of medical fitness signed by their medical provider prior to hunt date.

5. Hunting Experience

Have you hunted before?

Yes

Do you have your own hunting equipment?

Yes

Do you need equipment to be provided?

Yes

6. Goals and Interests

Why are you interested in participating in this guided hunting trip?

What do you hope to gain from this experience (e.g., connection to nature, relaxation, personal achievement)?

7. Required Documents

Please upload images or PDFs of your hunting tag and license.

Hunting Tag *

No file chosen

Hunting License *

No file chosen

8. Permissions and Agreements

I confirm that the information provided in this application is accurate to the best of my knowledge.

I understand that this application does not guarantee selection for the hunting trip.

I agree to complete and sign all required liability waivers prior to the trip.

Media Release (Optional): I grant permission for photos/videos of me to be used for promotional purposes.

Applicant Signature (Type Full Name)

Date

Submission Deadline

For questions or additional information, contact:

Kyle Thissell: (775) 934-9610 | kyle@northernnevadaoutfitters.org

Jayme Martinez: (775) 558-9355 | jayme@northernnevadaoutfitters.org

Medical Application