NAME:_________________PHONE(___)_________ID#(SSN OR DRIVERS LICENSE)_______________

ADDRESS__________________________________CITY___________STATE_____ZIP_______

The following is to be filled out by a licensed physician.

I do hereby attest that the above named individual is not able to use conventional archery 
equipment and must use a crossbow because:

TERMS OF PERMIT

1. Once completed and signed this application will be your HUNTING METHODS EXEMPTION PERMIT.
2. The permit holder is authorized to use a crossbow during archery seasons.
3. The crossbow must conform to provisions of applicable regulations.
4. All other statutes and regulations must be observed.
5. Permit holder must possess appropriate KY hunting licenses and tags.
6. This permit must be carried on person.
7. If the disability is a temporary one this individual must return to conventional hunting methods at the end of the time 
   specified above.
8. The Department of Fish and Wildlife does not maintain any copies of this permit. It is the responsibility of the user to 
   maintain this document.
9. The Department of Fish and Wildlife does not assume any responsibility or liability for any activity conducted under 
   this permit. The user assumes all risks and responsibilities.