Contact Gallant Heart

Contact Information

Email

info@gallantheartnj.org

Social Media

Facebook

Instagram

Veteran Crisis Line

Dial 988 then press 1

Veteran Programs

If you are a veteran and are interested in participating in one of our programs, please select a veteran program below.

Applications

Select a program below that you are interested in…

Wounded Veteran Pheasant Hunt Application

Gallant Heart is a non-profit organization that focuses on providing outdoor leisure activities to our Nation’s heroes. We pride ourselves on creating a supportive environment for veterans to experience camaraderie, brotherhood, and relaxation through hunting and social events. It is our mission to provide a cost-free experience and to play a role in their continued healing and quality of life. We do this with significant help from Three Sheets Pheasants, NJ Division of Fish & Game, and local donors and sponsors who are dedicated to our nation’s heroes. To be considered as an applicant for this event please complete the form below.and upload copies of your DD-214 (with SSN redacted) and VA Disability Ratings Sheet (for proof of 100% Service-Related disability).

First Name *

Last Name *

Gender *

Birth Date *

Birth Date

Address *

Address

Phone *

Email *

How did you find out about the program? *

Please write a brief explanation of why you would like to attend this event and how you believe it can help you. If you are nominating a veteran, please indicate in what ways you feel your nominee may benefit from the selected program. Please Include any information that you feel is applicable. *

Branch of Service *

If nomination, we need a place for the referrer name, email, phone number

Dates Of Service *

Select all that apply: *

Purple Heart Recipient

Permanent & Total Disabled

100% Service Connected (Disabled)

Less than 100% Service Connected

Not Service Connected

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Phone *

Disability *

Amputee – Above Knee

Amputee – Arm

Amputee – Below Knee

Amputee – Bilateral

Hearing Impairment

Multiple Sclerosis

Post Traumatic Stress Disorder

Seizures

Spinal Cord Injury

Stroke

Traumatic Brain Injury

Visual Impairment

None

OtherOther

Mobility *

Ambulatory without assistive device

Crutches / Walker / Cane

Manual Wheelchair

Power Wheelchair

Prosthetics

Scooter

OtherOther

If you have a disability, please provide any information you would like us to know that will help us accommodate you and your disability.

Please provide any information you would like us to know that will help us accommodate you and your disability.

*Please understand that we have many applicants each year. You may not receive an immediate reply, however you will be notified once all applications have been reviewed by the Board of Directors and participants have been selected.

Gallant Heart Hunter Mentor Program

The Hunter Mentor Program is specifically designed to engage active duty service members that have a great interest in hunting and the outdoors but need some guidance and experience to feel comfortable. Each hunter is paired with a mentor or mentor team to provide the best possible knowledge and experience.

Applicants are selected in the order they are received. To be considered as an applicant for this program please complete the form below and upload a copy of your current military ID.

First Name *

Last Name *

Gender *

Birth Date *

Birth Date

Address *

Address

Phone *

Email *

How did you find out about the program? *

Please write a brief explanation of why you would like to attend this program and how you believe it can help you. If you are nominating a service member, please indicate in what ways you feel your nominee may benefit from the selected program. *

Branch of Service *

Current Military Status *

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Phone *

If you have a disability, please provide any information you would like us to know that will help us accommodate you and your disability. *

Hoodie Size *

Small

Medium

Large

XXL

3XL

Vest Size *

Small

Medium

Large

XXL

3XL

Do you have a current or expired hunting license (from any state)? *

Yes

Do you have any food allergies? *

Yes

If yes, please list

I agree to and grant authorization to Gallant Heart for the use of any photograph, video or other digital medial taken of me at any Gallant Heart program or event in any and all of its publications, including print, video, or web-based publications for presentation under any legal condition including, but not limited to: publicity, copyright purposes, education, illustration, advertising, and web content. I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use. I understand that my authorization may never be revoked. *

Yes

reCAPTCHA

If you are human, leave this field blank.

Our Sponsors

Contact Us

Name *

Email *

Phone *

Message

reCAPTCHA