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Application Form For Prudence Island Special Season Deer Hunt For Paraplegic/double Amputee Hunters - Rhode Island Department Of Environmental Management

RHODE ISLAND

DEPARTMENT OF ENVIRONMENTAL MANAGEMENT

235 Promenade Street, Providence, RI 02908-5767

TDD 401-222-4462

Office of Boat Registration & Licensing

Floor, Room 360 (401) 222-6647

Application for Prudence Island Special Season Deer Hunt for

Paraplegic/Double Amputee Hunters

October 8-11 2013

Name: ______________________________________________________

Address: ____________________________________________________

City: ___________________ State: __________ Zip Code: ____________

Date of Birth: ____________

Hair Color: ______ Weight: _____ Eye Color: _______ Height: _______

*If additional information is needed please provide us with one of the following:

Phone number:__________________________ or Email address:______________________________

Bag Limit is One Antlered Deer and Two Antlerless Deer

(

) Resident $12.50 each (

) Non-Resident $25.50 each

New Applicants: A physician’s signature verifying that the applicant qualifies for this permit under the

rules and regulations establishing seasons, bag limits and methods of taking, for the protection of

certain species is required. Under rules and regulations for taking deer by paraplegic and double

amputee hunters on Prudence Island, 6(d); “paraplegic” for the Prudence Island special season shall

be: paraplegic means an individual afflicted with paralysis of the lower half of the body with

involvement of both legs.

Also, a copy of RI Permanent Hunting License or RI Hunting License must be submitted for new

applicants.

Renewals: Applicant is required to fill out top portion of application, sign and date. There is no

requirement for renewals to submit documentation.

Physician’s Signature___________________________________________Date____________

(new applicants only)

Applicant’s Signature___________________________________________Date____________

Notes: Checks/Money Orders payable to State of RI – DEM & mail or deliver to the address below

Mail to: RI DEM, 235 Promenade St., Room 360, Providence, RI 02908

Application Form For Prudence Island Special Season Deer Hunt For Paraplegic/double Amputee Hunters - Rhode Island Department Of Environmental Management

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