Apply For An Adventure

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The primary goal of Moment of Peace Adventures is to give your child a Moment of Peace. If accepted, your child and at least one parent will be treated to an all-expenses paid hunting or fishing adventure! Each adventure is tailored to your child’s situation and abilities. Your adventure will also include pictures and videos taken during the adventure that will then be used to create a photo album and DVD so you can share your adventure with family and friends! Depending on the adventure you are interested in, hunting or fishing, a mount of your trophy as well as standard processing are included. The most important thing about your adventure is that our goal is to give your child and you a Moment of Peace! To try and forget about doctors, hospitals, and treatments. To make memories that will last a lifetime and new friends as you are welcomed into the MOPA Family!

Eligibility Requirements:

Child must be 18 or under at time of submission of the application.
Child must have or had a life-threatening illness or severe physical disability.
This application must be filled out by a parent or legal guardian.
MOPA Representatives must be able to work with and communicate with the child during the adventure. Safety of the child and MOPA reps is our top concern on the adventure! The adventure is to be a Moment of Peace for the child and parent/legal guardian on the adventure. If the activities will be too stressful for the child, it’s not a Moment of Peace. There are some children or illnesses, or disabilities that we may just not be equipped to handle. If denied, we will try to give references to other organizations.
An interview between MOPA representatives and the applying family will be conducted to determine eligibility.

Download Application Form

About the Youth:

Name of Youth(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Height(Required)

Weight(Required)

T-Shirt Size(Required)

Sex(Required)

Male

Female

Parent(s) / Guardian(s):

List Parent(s) / Guardian(s)(Required)

Name

Relationship

Phone Number

Medical Condition:

Primary Diagnosis

Treating Physician's Name

First Last

Treating Physician's Address

Street Address Address Line 2 City State ZIP Code

Treating Physician's Phone Number

Is there a medical reason why we need to act quickly?

Upload a Doctor's Form

Accepted file types: pdf, Max. file size: 2 MB.

Sibling(s):

List Sibling(s)(Required)

Name

Relationship

Age

Other Information

How did you hear about Moment Of Peace Adventures?

What type of adventure is the youth interested in?(Required)

Fishing

Hunting