Physician's Certification | Ministry of Natural Resources and Forestry

This form is for the purpose of providing medical information for an Authorization to Hunt from a Stationary Vehicle or Motorboat.

Patient Information

Last Name

First Name

Date of Birth (yyyy/mm/dd)

Please provide a brief description below of the disability that would prevent the patient from dismounting the stationary vehicle or motorboat to discharge a firearm. Please indicate below the nature of the disability and if the disability is permanent or temporary. If it is temporary, please indicate the timeframe the disability will affect the person's ability to safely dismount a stationary vehicle or motorboat to discharge a firearm.

If additional information is required, please provide on a separate sheet.

Physician's Information

I hereby certify that this patient suffers from a severe disability that prevents the person from hunting except while using a wheelchair or similar means of locomotion including vehicles and motorboats, and is unable to safely dismount the stationary vehicle (including a wheelchair) or motorboat to discharge a firearm.

Last Name

First Name

Telephone Number

Unit Number

Street Number

Street Name

PO Box

City/Town

Province

Postal Code

Physician's Signature

Date (yyyy/mm/dd)