Application For Bloomington Cave Entrance Permit - United States Department Of The Interior Page 3

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E. Purpose of Visit: Recreation __ Geology__ Photography __ Education __ Research___
Other:______________________________________________________________________________
F. Parental or Legal Guardian Consent:
The consent of a parent or legal guardian is required for all individuals under 18 years of age who will not
be accompanied on the proposed cave trip by their parent or legal guardian.
As part of the application to enter the cave(s) administered by BLM, I consent to allow my child to
participate in the proposed cave trip. The trip leader named on this application form is delegated the
responsibility for the care and instruction of my child while he or she is in the cave(s). By my signature on
this form. I also agree on behalf of my child to be bound by the permit General Conditions and any
Special Stipulations that will apply to authorization for the cave visit.
CHILD'S NAME AND AGE (PRINT)
SIGNATURE OF PARENT OR LEGAL GUARDIAN
1._______________________________
________________________________
2._______________________________
________________________________
3._______________________________
________________________________
4._______________________________
________________________________
5._______________________________
________________________________
6._______________________________
________________________________
7._______________________________
________________________________
8._______________________________
________________________________
9._______________________________
________________________________

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