Permission For Hunting Or Trapping On Private Land
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1Permission for Hunting or Trapping on Private Land
Permission is hereby granted to the undersigned sportsperson for hunting/trapping on land owned by the
undersigned landowner or their agent for the date(s) listed and according to the conditions stated below.
Name: ___________________________________________________________________________
(hereinafter the “Permit Holder”)
Pennsylvania Hunting License No.: _____________________________________________________
Address (street): ___________________________________________________________________
(city):__________________________________ (state): _____________ (zip):__________________
Telephone: (________) ______________________________________________________________
Vehicle License No., Make, and Model: _________________________________________________
This Permit permits the above-identified person to enter and hunt upon my property located at
_________________________________________________________________________________
(the “Property”). This Permit is only valid for the individual identified above. No other person may use
this Permit. The Permit Holder is not entitled to bring any guests on to the Property. This Permit is
expressly conditioned upon the following terms and conditions:
The Permit Holder shall have a valid Pennsylvania Hunting License
The Permit Holder shall exercise appropriate care in the handling of all firearms, archery
equipment and/or other weaponry and will obey all of the hunting laws and regulations of the
Pennsylvania Game Commission and all other applicable local, state and federal laws,
regulations and ordinances.
The Permit Holder shall not damage fences, buildings, or other property
The Permit Holder shall not litter the area or dump any rubbish
This free Permit is only valid on the lands of the issuing landowner and only for the days
specified.
The Permit Holder must carry this Permit on his person while hunting on the Property.
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
agree and covenant to indemnify, defend and hold harmless
the issuance of this permit. Furthermore, I
the Property owner from and against all claims, losses, damages and costs (including reasonable
attorney fees and expenses) of any kind or nature and brought by any party, arising from my, or any of
my agents’, servants’, employees’, invitees or guests’ activities on the Property.
Hunting/Trapping Permission Period: (check one):
Daily
Seasonal
Hunting Season:_______________________________
Date(s): ______________ to _____________
________________________________________
_________________
Hunter’s Signature
Today’s Date
________________________________________
_________________
Today’s Date
Property Owner’s Signature
ND: 4831-1352-1451, v. 1 | 82000-184
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