Provided by Good Neighbor Law
P.O. Box 155
LaSalle, CO 80645

Please consider this signed agreement as permission granted to:
_____________________________________________________________________Grantee
Address: _______________________________________________________________
Phone #________________________________________________________________
To be admitted on the property of: __________________________________________Grantor
And to be confined to: _______________________________________________________
 
Please check one of the following:  Private citizen_________ Public Servant________

If Private Citizen: Organization Affiliation _______________________________________

(In addition to this agreement, Public Servant will be required to fill Public Servant’s Questionnaire pursuant to the Privacy Act of 1974, and attach to Grantor’s PAA.)

Grantee accepts full responsibility for his/her actions while on said property, and thereby waives Grantor of any liability what so ever.

Grantee agrees that he or she is a guest on Grantor’s private (includes allotment owner) property accepts burden of performance, and acknowledges any action not agreeable to Grantor authorizes Grantor opportunity to terminate agreement.

Grantee does not have permission to share any activity (includes hunting, fishing, dirt moving) or material (includes land, water, structure, fauna, flora, photography, electronic image or video) they see, with any government, government agent, government contractor, representative, private entity, non-profit agent, non-government public organization or non-profit private organization.

Grantee promises to: Notify Grantor prior to each time Grantee desires to enter property; exercise full consideration of this privilege granted; will be absolutely observant of keeping shut gates shut, not leave behind any material Grantee brings in; not remove any material from Grantor’s property; not intentionally bring damage to any part of the land, water, farm animals or livestock, and not move beyond area defined in agreement.

This agreement is non-transferable, and on a one-person only basis.

Grantee must have agreement available to show Grantor or any person Grantor authorizes to request show of said agreement; if Grantee fails to show requested agreement, Grantor or Grantor’s authorized person will hold right to terminate this agreement and demand Grantee leave of property immediately.
 
Agreement start date:________________ Agreement termination date:_____________________

Signed (Grantee) ________________________________________________________________

Signed (Grantor) _________________________________________________________________