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Thank you for your patronage from management and staff

Please, fill out the form below to apply for a permit. Please remember a deposit is required to secure your hunt.

Application for Permit and Hunting License: Your personal information is considered CONFIDENTIAL and is used only to obtain our Permit and Hunting License. This information is then shredded.

Party Size

Individual Group Hunt

Or With a Party Of:

Number In This Party?

Requested Hunt Date

First Choice:

Second Choice:

Class of Deer:

Hunter Information

Please fill out this form for each hunter

Full Name:

Home Phone No.:

Address:

County:

City:

State:

Zip:

Social Security Number:

SSN is mandatory pursuant to 42 U.S.C. 660(0)(13) & 5 ILCS 100/10-65© for the use under the State’s Child Support Enforcement Program

Driver’s License No.:

Issue Date:

Expiration Date:

Date of Birth:

Gender:

Race:

Caucasian African American Hispanic Other

Height (Ft./Inch.):

Weight (lbs.):

Hair Color:

Eye Color:

In case of emergency please provide an immediate contact:

Full Name:

Home Phone No.:

Office Phone No.:

Cell Phone No.:

I have voluntarily provided this personal information to Samson’s Ridge to obtain the necessary Permits for Hunting.

This information may be placed on file for further use of obtaining necessary permits for the purpose of hunting at Samson’s Ridge.

OR I oppose of my personal information being kept on file for further use. I request this information be destroyed after obtaining necessary permit.

Date of Application

All Requested Dates Must Be Secured With a $500 Deposit. Secure Your Hunt Today!

Please fill out your full name and click the “Pay Now” button below.

Call Len Rudd - Owner

Contact Us

Thank you for your patronage from management and staff

Hunter Information

Site Info

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Tony Bridges-Ranch Manager