Delaware County Feild and Stream
713 Chester Creek Rd.
PO. BOX1092
Brookhaven, Pa.  19015



Parent/Legal Guardian Permission Form


I, ___________________________________, BEING PARENT ____ LEGAL GUARDIAN ____


(PRINT NAME)


HEREBY GIVE MY CONSENT FOR ___________________________________________



(PRINT MINOR'S NAME)

TO SHOOT AT THE DELAWARE COUNTY FIELD & STREAM GUN CLUB. I HEREBY RELEASE ANY

AND ALL CLAIMS FOR LIABILITY AND NEGLIGENCE AGAINST THE DELAWARE COUNTY FEILD AND STREAM.


____________________________________________
SIGNATURE OF PARENT OR LEGAL GUARDIAN


_____________________________
DATE
 

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