GRD Hunt





Internet nickname (optional)_______________________________

Emergency contact: _____________________________ Phone:_______________________

List any medical conditions/allergies ______________________________________________________________________

I, ___________________________________ by my signature below, release and discharge the landowner(s), landowner heirs, leasee, manufacturers, Larry Cissna, or any other parties connected with the Larry Cissna hunt/campout, herein referred to as “Releasees”, of all law suits, actions and demands whatsoever, for all claims, accidents, loses, or injuries that may occur while participating in the Larry Cissna hunt/campout. I understand that the entry fee is non-refundable.
I hereby agree to indemnify and hold harmless the Releasees and their insurance carrier, and each of them from any loss, liability, damage or cost they may incur arising out of or related to the event(s) whether caused by the negligence of the Releasees or otherwise.

I will abide by the rules established by Larry Cissna, and property owners/caretakers.

Date: ____________________

Signature: _________________________

Printed Name: _____________________________

Mail completed form and 300.00 fee to

Larry Cissna
1412 Camellia Dr
Sweeny TX 77480