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Chatsworth ATV Rentals, LLC.
Letter Of Parental Consent
As Parent(s) / Legal Guardian(s), I / we give permission for ___________________________________________
(Name of Minor Child)
to ride off road vehicles at Chatsworth ATV Rentals, LLC, Inc. in Columbus, NJ. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless ATV Rentals from any and all claims, demands, or causes of action, which are in any way connected with my child's participation in this activity or my use of ATV Rentals’ equipment or facilities, including any such claims which allege negligent acts or omissions or ATV Rentals. In the event of injury and in my/our absence, I / we authorize
_____________________________________________ and the Staff of Chatsworth ATV Rentals, LLC. to act on my / our behalf
(anyone other than a parent who may bring this/these minor(s)) regarding emergency medical attention. In signing this consent form, I agree to all that is stated in the parental consent release, waiver of liability, assumption of risk, and indemnity agreement that must be signed each time my child rides at Chatsworth ATV Rentals, LLC. by the responsible adult they are accompanied by. This authorization is for the duration of (one day) or (one year) from the date of this letter. (Circle One)
INSTRUCTIONS:
· Do not leave anything blank follow the directions below.
· If divorced, write in “sole custody” or obtain the other parents signature.
· If a parent is deceased write in "Deceased"
· Any person other than a parent that will be bringing the minor(s) must be listed in the space provided above.
Father or Guardian (Circle One)
Parent Signature: ______________________________________________________ Date: ________________
Print Name: ___________________________________________________________
Address: ______________________________________________________________________________________
Mother or Guardian (Circle One)
Parent Signature: ______________________________________________________ Date: ________________
Print Name: ___________________________________________________________
Address: ______________________________________________________________________________________
Notary Public:
Subscribed and sworn before me this ________day of ____________________, 20________
Signature: ___________________________________________ Date: _________
Print Name: __________________________________________
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