Heroes New Hope Event Registration

Event Registration Form

First Name, Middle Initial *

Last Name *

Address 1 *

City, State *

Zip Code *

Gender *

Height *

Weight *

Birth Date *

Shirt Size *

Email Address *

Best Contact Phone Number *

Are you a veteran?*

2022 Summer Fishing Event September TBA2021 Fall Deer Hunt NOV TBA2022 Youth Spring Turkey Hunt TBA2022 Veteran Spring Turkey Hunt TBA

Please tell us what you hope to take away from this experience? *

Is this your first event of this kind?*

Emergency Contact Name *

Relationship to You *

Emergency Contact Phone *

Emergency Contact Email *

Primary Physician Name *

Primary Physician Phone *

History of Seizures? *

Do You Have a Shunt? *

Any Surgeries within the Last Year? *

Are you an amputee? Please provide us details so we can provide adaptive equipment for you to use. *

Do you have any allergies? Please list. Can an allergic reaction be life-threatening to you? If so, please list what medications or interventions you may require such as an EpiPen etc. *

Please tell us about any special dietary needs you may have. Low calorie, low sodium, vegetarian, religious, etc. *

In detail, please describe your disability and/or diagnosis. *

Please describe your level of mobility and list any equipment you have that assists you. *

Please list the medications you are taking and any assistance you may need such as dosage reminders, taken with food, etc. *

If you take medication, are there any side effects that may affect your event participation? *

Please add any information not already addressed related to your medical history you feel we need to be aware of. *

Please tell us about your service animal and any accommodations he or she may need or special instructions. *

Please tell us the type and brand of food your service animal requires. *

Veterinarian name and phone (in case of emergency) *

Please tell us about any daily living accommodations you need such as a modified restroom, shower, vehicle, lift or ramp etc. *

Please tell us about any accommodations you and/or your service animal would need if using public or commercial transportation to attend this event. Aisle seating, etc. *

Is there anything you would like to add to your registration? A veteran event mentor will contact you shortly after you have submitted your registration. If you have any questions, feel free to list those here.

How did you hear about Heroes New Hope Foundation?