Landowner/Land User Agreement Card – Land user copy I am requesng permission from _________/__________/ _________ to _________/ _________/ __________ to access your property for the purpose of _______________________________________________________ (e.g. hunng, trapping, fishing) Landowner’s Name: _________________________________________________________________________ Address: __________________________________________________________________________________ Home Phone: _______________________________ Cell Phone: ____________________________________ Landowner/Land User Agreement Card – Landowner copy Land User’s Name: ___________________________________ License Number: ________________________ Address: ___________________________________________________________________________________ Home Phone: ____________________________________ Cell Phone: _______________________________ Vehicle Model: _________________________ Color: _________________ License Plate: __________________ Vehicle Model: _________________________ Color: _________________ License Plate: __________________ Permission granted to use the property from ______/_______/_______ to _______/_______/________ for the purpose of _____________________________________________________________________________ (e.g. hunng, trapping, fishing) Landowner/Land User Agreement Card – Land user copy I am requesng permission from _________/__________/ _________ to _________/ _________/ __________ to access your property for the purpose of _______________________________________________________ (e.g. hunng, trapping, fishing) Landowner’s Name: _________________________________________________________________________ Address: __________________________________________________________________________________ Home Phone: _______________________________ Cell Phone: ____________________________________ Landowner/Land User Agreement Card – Landowner copy Land User’s Name: ___________________________________ License Number: ________________________ Address: ___________________________________________________________________________________ Home Phone: ____________________________________ Cell Phone: _______________________________ Vehicle Model: _________________________ Color: _________________ License Plate: __________________ Vehicle Model: _________________________ Color: _________________ License Plate: __________________ Permission granted to use the property from ______/_______/_______ to _______/_______/________ for the purpose of _____________________________________________________________________________ (e.g. hunng, trapping, fishing)
Transcript
Landowner/Land User Agreement Card – Land user copy
I am requesting permission from _________/__________/ _________ to _________/ _________/ __________
to access your property for the purpose of _______________________________________________________ (e.g. hunting, trapping, fishing)
Permission granted to use the property from ______/_______/_______ to _______/_______/________ for
the purpose of _____________________________________________________________________________ (e.g. hunting, trapping, fishing)
Landowner Liability Release: Landowners permitting use of their property for recreation without charging a fee are not liable for injuries to recreational users of their property except in cases of willful, wanton, or reckless conduct by the owner. (MGL Ch. 21 § 17C)
For the privilege of using private property, I pledge to:• Respect the landowner, going only where they designate; and I assume liability for my actions while on this property.• Respect the landowner’s property, taking every precaution against littering and fire and will leave the land as I found it.• Obey all wildlife and other laws and respect and follow any additional instructions as stated by the landowner.• Observe all safety precautions and the ethics of good sportsmanship.
Land User’s Signature __________________________________________________ Date __________________
I hereby give permission to _________________________________________________ to access my property
located at _________________________________________________________________________________.
He/she has agreed to act safely, responsibly, and lawfully and to accept responsibility for his/her actions.
Special Instructions: _________________________________________________________________________
Landowner’s Signature _______________________________________________ Date ___________________
Landowner Liability Release: Landowners permitting use of their property for recreation without charging a fee are not liable for injuries to recreational users of their property except in cases of willful, wanton, or reckless conduct by the owner. (MGL Ch. 21 § 17C)
For the privilege of using private property, I pledge to:• Respect the landowner, going only where they designate; and I assume liability for my actions while on this property.• Respect the landowner’s property, taking every precaution against littering and fire and will leave the land as I found it.• Obey all wildlife and other laws and respect and follow any additional instructions as stated by the landowner.• Observe all safety precautions and the ethics of good sportsmanship.
Land User’s Signature __________________________________________________ Date __________________
