I hereby agree to conduct myself
as a sportsman in the true sense
of the word and I accept the
responsibilities which are a part
of hunting and fishing.

• I will not commit any act of
vandalism on the landowner
property.

• I will report to the landowner
all such acts observed.

• I will not hold the landowner
responsible for any accidents
while on his/her property.

• I will not litter.

Date______________________________________ No.__________

Name___________________________________________________

Address_________________________________________________

_______________________________________________________
        City                                       State                       Zip

Phone # _________________________________________________

Vehicle make _________________ License # ____________________

Hunting license #__________________________________________

Landowner name __________________________________________

Property Description ________________________________________

Dates permission granted ____________________________________

Landowner signature ________________________________________

Date ____________________ No. ____________________

Date Permission Granted ____________________________

Name ___________________________________________________

Address _________________________________________________

Phone # _________________________________________________

Vehicle Make _______________ License # ______________________

Hunting License # _________________________________