S & M HUNTING LODGE, Inc. RELEASE FORM

#1. CHCECK ONE OF THE FOLLOWING FIVE SCENARIOUS:

#2. By signing this document, I am declaring that, as a result of my PERSONAL ACTIONS, my rights to possess or use a firearm HAS NOT BEEN REVOKED by any Country, State or local government agency.

Read and adhere to S & M Hunting Lodge's safety rules.

#1. Pennsylvania Game Commission laws apply to everyone while hunting, fishing and dog training on S & M property.

#2. Blaze orange vest and hat also protective eye wear is required while hunting.

#3. Protective eye wear and hearing protection are required for the sporting clay area.

#4. Children under the age of 13 with a valid hunter license must be accompanied by a blood relative that is a shareholder and will only be allowed to hunt on the back 55 acres.

#5. Limit of 5 people per hunting party, no more than 2 dogs in the field with any one party at one time. Shot sizes are limited to 5, 6, 7 or 7½.

The undersigned recognizes that the activities at S & M Hunting Lodge, Inc., are dangerous sports that have the potential to cause bodily injury or damage to personal property. Accordingly, in consideration of being permitted to participate in such activities, the undersigned hereby agrees to indemnify, release, and hold harmless S & M Hunting Lodge, Inc., and its officers, directors, representatives, shareholders, agents, employees, invitees, and licensees against any and all liabilities, costs, or claims arising in any way, out of the use of the property of S & M Hunting Lodge, whether such liabilities, costs or claims are in connection with loss of life or personal injury to any person or with damage to or destruction of any property. The undersigned hereby waives any and all claims he or she may have against S & M Hunting Lodge, Inc., arising out of the use of its facilities, and S & M Hunting Lodge, Inc., shall not be liable for any damages or injuries to persons or property whether or not caused by S & M Hunting Lodge, Inc., or any of its officers, directors, representatives, agents, employees, invitees, or licensees.

The undersigned hereby agrees that he or she has read and understands this agreement in detail and will comply with all terms of same. This agreement shall be binding upon the undersigned and the undersigned's heirs, successors, personal representatives, and assignees.

The undersigned understands that the foregoing representations, as well as the release and indemnity, will apply to this current hunting season. The undersigned further will immediately advise S & M Hunting Lodge, Inc., if there is any change in the status of the representations heretofore made.

INDIVIDUALS UNDER THE AGE OF 18 REQUIRE PARENT OR LEGAL GUARDIAN SIGNATURE