Disabled Veteran Application

Apply for hunting opportunities through Camp Hero Arizona. This program serves veterans with service-connected disabilities as defined under Arizona HB 2303.

Camp Hero Arizona

Disabled Veteran APPLICATION

Arizona HB 2303 ◆ Veteran Tag Transfer Program

Camp Hero Arizona: Complete this form to apply for a disabled veteran hunting opportunity. Contact: [email protected] | (602) 930-5007

Hunter Information

Name:

Date of Birth:

Age:

Social Security #:

Sex:

Male Female

Height:

Weight:

Eyes:

Hair:

Hunter's Address:

City:

State:

Zip:

Emergency Contact Information

Emergency Contact #1:

Name:

Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Email:

Emergency Contact #2:

Name:

Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Email:

Medical

Physician Name:

Hospital / Treatment Facility:

Address / City / State / Zip:

Office Phone:

Fax:

Email:

HB 2303 — Veteran Tag Transfer

In 2014, Arizona passed HB 2303 which now allows for the transfer of certain big game tags to qualified organizations for the purpose of providing hunting opportunities to disabled veterans who have permanent physical disabilities.

17-332.04. Special big game license tags; qualifying tax-exempt organizations; transfers

A. A qualifying tax-exempt organization may accept the transfer of a valid big game species special license tag from a tag holder who has been issued a special license tag for any open big game season, who has purchased point guard for the applicable species and who desires to transfer the tag to the qualifying tax-exempt organization for the purposes prescribed in subsection B of this section.

B. A qualifying tax-exempt organization that has been issued a transferred tag pursuant to this section may use that tag for the purpose of providing a hunting opportunity in this state to a veteran who has a permanent physical disability.

"Disability" means a permanent physical impairment that substantially limits one or more major life activities requiring the assistance of another person or a mechanical device for physical mobility.

C. A qualifying tax-exempt organization that has been issued a transferred tag may allow a veteran to use the tag if the veteran meets the qualifications prescribed in subsection B of this section and the veteran is certified in writing by the veteran's physician or other health care provider as meeting the requirements of subsection B of this section.

D. For the purposes of this section, "qualifying tax-exempt organization" means a charitable organization that has tax-exempt status under section 501(c)(3) of the internal revenue code and whose mission is to provide hunting opportunities in this state to disabled veterans who have permanent physical disabilities.

NOTE: The percentage of disability is NOT used as a method to qualify an applicant as meeting the qualifications of HB2303. Only a permanent physical disability as defined in section 23-1044 of the Arizona Revised Statutes will qualify an applicant. This definition requires that the disability substantially limits one or more major life activities requiring the assistance of another person or a mechanical device for physical mobility.

Hunter Education & Licensing

Have you completed a Hunter Education class?

Yes No

If yes, what state?

What is your hunter ed number?

CHAMP information (if applicable):

Do you currently have an Arizona Hunting License?

Yes No

License #:

EXP:

Do you currently have an Arizona Customer ID?

Yes No

ID #:

Note: A Social Security Number will need to be provided to Arizona Game & Fish Department in order to have hunting licenses transferred. This process will be handled through Camp Hero and Arizona Game & Fish Department.

Health Care Provider Page

I certify that the below named applicant meets the requirements for Veteran Tag Transfer as follows per HB2303:

"Disability" means a permanent physical impairment that substantially limits one or more major life activities requiring the assistance of another person or a mechanical device for physical mobility.

The Health Care Provider credentials listed below shall be one of the following: Medical Doctor, Doctor of Osteopathic Medicine, Doctor of Naturopathic Medicine, Physician's Assistant, or Registered Nurse Practitioner.

Signature of Doctor:

License #:

Applicant Name:

Date:

Health Care Provider Phone:

Health Care Provider Email:

Notary Section

State of:

County of:

Subscribed and sworn before me this ___ day of __________, 20___

Notary Public Signature:

My commission expires:

(Notary Seal)

WARNING: Any person who knowingly makes a false statement or conceals a material fact in this application is subject to criminal prosecution under applicable Arizona law.