Please complete the following form completely.  Failure to provide complete information may delay the application process.  Forms must be completed by a parent or guardian.  Waiver forms must be signed by a parent or legal guardian at the time of the adventure.

Qualification Criteria:
     - Must be from Eastern North Carolina.
     - Must be diagnosed with a disability or life threatening illness.
            (Parent may be asked to provide a doctor statement confirming disability or life threatening illness.)

*A parent or guardian must accompany the candidate on the adventure.
**For a hunting adventure, candidate must be at least 9 years old.
***For a fishing adventure, candidate must be at least 5 years old.