Recreational Activities Permission Form – Fill Out and Use This PDF

Permission to Enter Private Land

for Recreational Activities

Permission is hereby granted to the undersigned sportsperson for entry into private land owned by the undersigned landowner or their agent for the date(s) and activities listed. The permission is according to the conditions stated on the reverse side of this permit.

Hunt	Trap	Fish	Harvest Ginseng
Permission Period
Seasonal - Through February 28, 20 _______
Daily - Valid From Date(s) ____/_____/____			to ____/_____/____

______________________________________________________________

Landowner or Agent’s PRINTED Name

________________________________________ ______/______/______

Landowner or Agent’s Signature

Today’s Date

In accepting this permit, I agree to assume and release the landowner from any or all liability for personal injuries, property damage, or for the loss of life or property resulting from, or in any way connected with the issuance of this permit.

Customer ID No. ________________________________________________

Sportsperson’s Address: ___________________________________________

(street)

______________________________________________________________

(city, state, zip code)

Sportsperson’s Telephone (________) _________________________________

Vehicle License No., Make, and Model: _________________________________

______________________________________________________________

______________________________________________________________

Sportsperson’s PRINTED Name

________________________________________ ______/______/______

Sportsperson’s Signature

Today’s Date

Ohio Revised Code 1533.181: Exemption from liability to recreational users

(A)No owner, or lessee, or occupant of premises:

(1)Owes any duty to a recreational user to keep the premises safe for entry or use;

(2) Extends any assurance to a recreational user, through the act of giving permission, that the premises are safe for entry or use;

(3) Assumes responsibility for or incurs liability for any injury to person or property caused by any act of a recreational user.

1-Landowner or Agent - 2-Sportsperson

DNR 8924 (R0914)