LAND ACCESS PERMISSION - Respect - Ask - Share - Thank-
IDNR Law Enforcement 1-877-236-7529
TO BE RETAINED BY LANDOWNER
User’s Name_______________________________________
Address _________________________________________
City _____________________________________________
State ______________________ Zip ___________________
Phone (work) __________(home) _____________________
Vehicle Description License Number ___________________
Make ________________Model ___________ Color _______
Time period and Activities Permitted and Additional Information:
___________________________________________________
In return for the privilege to use private land, I agree to abide by landowner rules, obey all laws,
and conduct myself in a safe and ethical manner and release and waive any claim against the
landowner for personal injury.
User’s Signature _____________________________________________________________
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TO BE RETAINED BY USER
User’s Name_______________________________________
Activities Authorized _________________________________
Date/Times of Authorized Use__________________________________________________
Landowner’s Name _________________________________________________________
Describe Property to be Used __________________________________________________
Additional Information _______________________________________________________
Landowner’s Phone _______________________________________
Landowner’s Initials (or Signature optional) __________________________________________
