I,, my driver’s license is, , my current home address is, , and my home telephone number is, , I am the natural, adoptive parent, or legal guardian (and NOT the Step-parent) of the minor child (under 18 years of age)
, whose date of birth is,
I hereby authorize the following listed party or parties, whom I personally know to be 21 years of age or older, to bring the above-referenced child into On- Target Indoor Shooting Range, LLC, to shoot various firearms. The adult party has been instructed that helshe must be with the minor child at all times while the minor child is in the shooting areas of the range. I understand and acknowledge that this Authorization form shall be on file with On-Target Indoor Shooting Range, LLC, and shall be effective as long as the minor child is a minor (under 18 years of age). or until my written request to terminate this Authorization. Only the following person(s) is authorized to bring my child shooting.