Youth Hunter Application

Apply for hunting opportunities through Camp Hero Arizona. This program is designed for youth with life-threatening medical conditions or permanent physical disabilities under Arizona HB 2303.

Camp Hero Arizona

Youth APPLICATION

Arizona HB 2303 ◆ Youth Tag Transfer Program

Camp Hero Arizona: Complete this form to apply for a youth 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:

Legal Guardian Contact Information

Guardian #1:

Name:

Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Email:

Guardian #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 — Youth 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 youth who have life-threatening medical conditions or 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 minor who either:

1. Has a life-threatening medical condition as defined in section 36-2901.

2. Has a permanent physical disability as defined in section 23-1044.

C. A qualifying tax-exempt organization that has been issued a transferred tag may allow a minor to use the tag if the minor meets either of the qualifications prescribed in subsection B of this section and the minor is certified in writing by the minor'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 minors who have life-threatening medical conditions or 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 life-threatening medical condition as defined in section 36-2901 or a permanent physical disability as defined in section 23-1044 of the Arizona Revised Statutes will qualify an applicant.

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 Youth Tag Transfer as follows per HB2303:

1. Has a life-threatening medical condition as defined in section 36-2901.

2. Has a permanent physical disability as defined in section 23-1044.

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.