Club Registration
Name: _________________________________________________________________
Address: ________________________________________________________________
City: ____________________________________State: _____ Zip Code: ___________
Phone: _________________________ Email: __________________________________
Date of Birth: __________Type of Membership_________________________________
DISCLAIMER
Hunting and the use of firearms are dangerous activities. It must be understood by all participating members that DeHart’s Hunting & Recreation Club can assume NO responsibility for accidents involving firearms, tree stands, wild animals, vehicles, weather or any other hazards either natural or man made. DeHart’s Hunting & Recreation Club will provide a place to hunt and for recreation. It will not provide room and board or guide service. DeHart’s Hunting & Recreation Club does not guarantee the harvesting of any game. Each member is expected to rely on his or her own hunting skills and woodsmanship to ensure a rewarding hunting experience.
I acknowledge that hunting is a dangerous sport. I agree that I will not hold DeHart’s Hunting & Recreation Club, it’s officers, agents or associates responsible for any accidents or dangers that may befall me while hunting on, traveling to or from, the property or any accident or illnesses which may result from activities associated with DeHart’s Hunting & Recreation Club or it’s leased property.
Signature: _______________________________________________________________
Parent Signature for minor child: _____________________________________________
Credit Card #________________________ EXP ___/____ Security Code ____
Name on Credit Card _____________________________________________
Make check payable to Clyde DeHart and mail to
1414 Kings Run Road, Shinglehouse, PA 16748