Letter Of Parental Consent

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. 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: __________________________________________