Mobility Impaired Access Permit Application Form
This form is required for individuals with severe mobility impairments seeking a Mobility Impaired Access Permit. It outlines the necessary information and terms required for completion. This application is essential for ensuring accessibility in hunting and fishing activities.
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How do I fill this out?
To fill out the Mobility Impaired Access Permit application, start by entering your personal details such as name, address, and phone number. Next, obtain a statement from a Kentucky-licensed physician confirming your mobility impairment. Finally, sign the form to agree to comply with all the terms outlined in the permit.
How to fill out the Mobility Impaired Access Permit Application Form?
1
Provide your personal information including name and contact details.
2
Get a physician's statement confirming your mobility impairment.
3
Review the terms and conditions of the permit.
4
Sign the application to acknowledge your understanding.
5
Submit the form as instructed.
Who needs the Mobility Impaired Access Permit Application Form?
1
Individuals with permanent paralysis of one leg.
2
Persons with an amputated foot.
3
Those confined to a wheelchair or reliant on crutches.
4
Individuals with serious lung or cardiac conditions.
5
Patients requiring portable oxygen due to their health conditions.
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1
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What are the instructions for submitting this form?
To submit this form, please send it to the Kentucky Department of Fish and Wildlife Resources at the provided mailing address. Include any required documents, such as the physician's statement along with the application. If you prefer quicker processing, you may submit it via fax or any online submission options available through the department's website.
What are the important dates for this form in 2024 and 2025?
The application will be valid from March 1, 2024, to February 28, 2025. Ensure that your permit is renewed each year before the expiration date. All relevant documentation should be submitted by the application deadline.
What is the purpose of this form?
The purpose of this form is to provide mobility-impaired individuals the ability to apply for special access privileges in Kentucky's wildlife management areas. It facilitates recreational opportunities for individuals with severe mobility limitations, ensuring they can participate in outdoor activities like hunting and fishing. Ultimately, this application empowers individuals with mobility impairments, promoting inclusivity in outdoor recreational activities.
Tell me about this form and its components and fields line-by-line.
- 1. Name: Full name of the applicant.
- 2. Phone: Contact number for the applicant.
- 3. ID#: Social Security Number or Driver's License number.
- 4. Address: Residential address of the applicant.
- 5. City: City of residence.
- 6. State: State of residence.
- 7. Zip: Postal code.
- 8. Physician's Statement: A certified statement regarding the applicant's mobility impairment.
- 9. Signature: Signature of the applicant acknowledging the terms.
- 10. Date: Date of application submission.
What happens if I fail to submit this form?
Failing to submit the form correctly may result in delays or rejection of your permit application. It is crucial to provide accurate and complete information to ensure eligibility. Ensure that a physician's statement is attached to validate your application.
- Incomplete Application: Your application may be considered invalid if any required fields are left unfilled.
- Missing Physician Statement: Without a statement from a licensed physician, your application cannot be processed.
- Signature Omission: Failure to sign can lead to immediate rejection of your application.
How do I know when to use this form?
- 1. Access for Mobility-Impaired Individuals: Use this form to gain hunting and fishing access for those with severe mobility restrictions.
- 2. To Legally Hunt or Fish: This permit allows legally hunting or fishing from a vehicle, under specific terms.
- 3. Designate an Assistant: The applicant can appoint an assistant to aid in tracking and retrieving game.
Frequently Asked Questions
What is a Mobility Impaired Access Permit?
This permit allows mobility-impaired individuals to access certain areas for hunting and fishing.
How can I apply for the permit?
Complete the application form with your details and a physician's statement.
What if I have trouble filling out the form?
Feel free to reach out for assistance through our support channels.
Is there an expiration date for the permit?
The permit is valid for one year, from March 1 to the last day of February.
Can I edit the PDF after saving?
Yes, you can re-upload the saved PDF to PrintFriendly for further edits.
Do I need to have a physician's statement?
Yes, a statement from a Kentucky-licensed physician is required.
What happens if I lose my permit?
It is recommended to keep a backup; however, you will need to reapply.
Can I share the permit digitally?
Yes, PrintFriendly allows for easy sharing of your completed documents.
Are there specific areas designated for use with this permit?
Yes, designated areas are listed under the program guidelines.
Can my assistant use the permit?
Yes, you may designate one qualified assistant to assist you.
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