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Participant Volunteer
A. General Information
Name:*
Sex:
Address:*
Date of Birth:*
City:*
Hair Color:
State:*
Eye Color:
Zipcode:*
Height:
Home Phone: Weight:
Cell Phone:    
Email:*
Passport Number:
B: Service Information
Branch:
Rank:
Service From: to:
Duty Summary:
Treatment Facility/Hospital (if applicable):
Summary of Injuries or Physical Limitations:
Special Needs or Accomodations:
C: History
Any prior arrests or convictions? Yes   No  
If yes is checked above, please explain:
Have you ever hunted before? Yes   No  
Have you ever completed a hunter's safety course? Yes   No Hunter Safety #:
Have you ever participated in any other program such as this? Yes   No  
       
I certify that the above is true to the best of my knowledge and that, if selected to participate, will provide verification if requested by Freedom Care Warrior Project.
Name:*
Date:*


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