GRD Hunt
RELEASE / ENTRY FORM
Name__________________________________________________
Address________________________________________________
City/State/Zip___________________________________________
Email__________________________________________________
Phone______________________________
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