Please read the regulations below. By checking "yes," you agree to each regulation.

Name

Firstrequired

Middlerequired

Lastrequired

Address

Address 1required

Address 2

Cityrequired

Staterequired

Ziprequired

Phone (xxx) xxx-xxxx

Phonerequired

Email required

The permit will be valid only on District-owned property at Town Line Road and Route 364 in the Town of Middlesex.*

Yes No

Hunting and Fishing is only permitted in season.*

Yes No

All DEC regulations apply.*

Yes No

Hunting/Fishing is permitted only on days when school is NOT in session. *

THIS DOES NOT COUNT AFTER SCHOOL, 3PM-TILL DURING THE WEEK. See shaded areas on the back of your permit. You may walk the property after school hours; however, hunting/fishing is NOT allowed.

Yes No

All hunters/Fishers are required to sign in and out of the property at the kiosk located in the parking area on Town Line Road.*

Yes No

Hunters are required to report all game harvested when they sign out.*

Yes No

All tree stands must be registered with a tag issued by the District Office. Tag must be displayed on the tree stand at all times. Tree stands must be removed at the end of the hunting season (10/29-12/18). No destruction of vegetation.*

Yes No

The permit is valid for use only by the permit holder.*

Yes No

The sticker permit must be displayed in your vehicle, and the paper hunting permit must be carried by the hunter and displayed in the vehicle.*

Yes No

I am a District resident.*

Yes No

No hunting structures of any kind are to be erected anywhere on the property *See tree stand regulation. The District reserves the right to remove any property at any time.*

Yes No

The district is not responsible for any lost, stolen or damaged property of any kind.*

Yes No

Any person(s) not following regulations will have permissions revoked.*

Yes No

Permits expire on July 1, of each year.*

Yes No

The District reserves the right to rescind a permit at any time.*

Yes No

What will you be hunting? Check all that apply.

Small Game

Checkbox

Big Game

Checkbox

Water Fowl

Checkbox

Fishing

Checkbox

In order to process your application, you must provide the district with valid identification (Driver's License) and a CURRENT hunting permit displaying your name and hunting permit number. Please upload below.

Attach Filerequired

Max file size: 10 MB

I have read and agree to comply with the regulations for hunting on the Town Line Rd. Property permitted on this application.

Signaturerequired

Date required (mm/dd/yyyy)

Please send a confirmation email to the address below*:

Please provide an email address where we can send a link to your current form.

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