HomeMy WebLinkAboutForm 1_IC Application for Bow Hunt ProgramIowa City Police Department | p: 319-356-5275 Form #1
410 E. Washington Street | Iowa City, Iowa 52240 Page 1 of 4
Application for Iowa City Deer Management Bow Hunt Program
*Non Legible Applications Will Be Returned*
Hunter’s First, Middle & Last Name Email Address
Street Address, City, State & Zip Code
Cell Phone Number Alternate Phone Number
1st Emergency Contact Name & Number 2nd Emergency Contact Name & Number
Hunter’s Iowa Driver’s License Number Hunter’s Iowa DNR Customer ID #
Vehicle to be used during hunt:
Year Make Model Color License Plate #
Have you ever been arrested or charged with a crime (other than traffic violation)? Yes No
If yes, list below the arrest/charge date (if not sure, give approximate date), charging agency, charge(s) and disposition. If you were
convicted of a felony please notate next to the disposition.
Have you ever had contact with the Iowa Department of Natural
Resources which resulted in an enforcement action taking place? Yes No
If yes, list below the incident date (if not sure, give approximate date), county of where incident took place, violation/reason for
enforcement action and the disposition.
My initials are an acknowledgement of my understanding and permission for the Iowa City Police
Department to conduct a criminal history background check. I understand any false information or
non-disclosures will result in immediate removal of the program.
Iowa City Police Department | p: 319-356-5275 Form #1
410 E. Washington Street | Iowa City, Iowa 52240 Page 2 of 4
As an Applicant to the Bow Hunt Program, your initials indicate you agree to the following:
Include a copy of my Iowa DNR Hunting License.
To be at least 18 years old or older on the day of the hunt.
To take all shots at least six (6) feet up in a manufactured elevated stand which has an approved safety
harness; each hunter is encouraged to use a TMA or ASTM certified harness.
To NOT shoot within 150 feet (25 yards) or less of a home or any building, NOT shoot back into the distance
separation; except (do NOT check unless it is applicable).
(1) when hunting own property while adhering to distance requirement from adjoining property
owner structure;
(2) other property owners(s) waives distance requirement in written statement filed with the City;
To NOT position or use an elevated stand within 150 feet (25 yards) of any recreation trail, road, park, school,
or right-of-way; and NO shot shall be taken that may cross or enter into the same.
To shoot downward and no further than 75 feet (25 yards) from an elevated stand, and attempt to retrieve every
arrow.
To case all bows while traveling to and from the site to the hunting stand.
To follow DNR Hunting guideline, except when the City regulations are more restrictive than State regulations.
To follow all the requirements set forth in Iowa City Bow Hunt Program “Application Process and Instructions;
Rules; and Other Information.”
To follow H.U.S.H. (Help Us Stop Hunger) drop off guidelines. I understand dropping off deer not properly field
dressed, iced or spoiled can be cause for my removal from the program.
I acknowledge the Urban Hunt coordinator will have constant communication with all H.U.S.H. participating
packing plants and give my consent for any infractions to be reported. I understand any infraction can be
cause for my removal from the program and or being removed/suspended from the buck incentive award
program.
I understand participating in this program is a “PRIVILAGE AND NOT A RIGHT”. I also understand
and acknowledge I can be removed from the program at any time.
Hunter’s Signature Date Signed
Iowa City Police Department | p: 319-356-5275 Form #1
410 E. Washington Street | Iowa City, Iowa 52240 Page 3 of 4
Voluntary Authorization Release
Please read each statement carefully. Place your initials next to each statement to indicate you have
read and understand its content.
By signing this voluntary authorization, the hunter on behalf of his or her own self and their heirs,
assigns and legal representatives agree to release and hold harmless and indemnify the City of Iowa City, its
officers, agents, representatives, employees, and other participating parties to this special hunt, from any law
suit or action that is made or brought against the City for all activities associated with the Iowa City Deer
Management Bow Hunt Program.
While the City does not require you to provide proof of insurance, you are encouraged to consult your
insurance agent regarding liability insurance and/or umbrella insurance that may provide you with coverage
for your potential liability to the City or others while you engage in
bow hunting.
I have read and understand all the requirements set forth in “Application Process and Instructions;
Rules; and Additional Information.”
My voluntary signature confirms I have reviewed the above statements and have a clear understanding of
their content, and in doing so I release and hold harmless and indemnify the City of Iowa City, its officers,
agents, representatives, employees, and other participating parties to this special hunt, from any law suit
or action that is made or brought against the City for all activities associated with the Iowa City Deer
Management Bow Hunt Program.
Hunter Signature Date
Iowa City Police Department | p: 319-356-5275 Form #1
410 E. Washington Street | Iowa City, Iowa 52240 Page 4 of 4
Property(s) Requested to be Hunted (limit to four per hunter): Property #
Property Owner Property Manager
Name of Property Owner/Property Manager Email Address
Address of Property to be hunted
Cell Phone Number Alternate Phone Number
Will this property require a Waiver of Separation? Yes No
Will the property be shared by another approved Iowa City Urban Bow Hunter? Yes No
If yes, name of hunter:
NOTE: Merely sharing property on paper to increase your property locations will not be accepted and could be cause for
removal.
Hunters: Please advise the property owner/manager that the Iowa City Police Department or DNR may make contact with
them by telephone or/and in person to inspect the property to be hunted, verify accuracy of information, or to address any
questions/concerns.
Waiver of Separation Requirement: If property requires more than three waivers, the property cannot be hunted.
Please advise all grantors of the waiver that the Iowa City Police Department and/or DNR may make contact with them
by telephone or/and in person to inspect location, verify accuracy of information or to address any questions/concerns.
Waiver Information # 1: Property Owner(s) Name to Grant Waiver
Address of Property
Cell Phone Number Alternate Phone Number
Waiver Information # 2: Property Owner(s) Name to Grant Waiver
Address of Property
Cell Phone Number Alternate Phone Number
Waiver Information # 3: Property Owner(s) Name to Grant Waiver
Address of Property
Cell Phone Number Alternate Phone Number