PERMISSION TO COLLECT AND RELEASE FROM LIABILITY
GLACIER PEAK MINING LLC
| Name: ____________________________________ | Phone No. __________________________ |
| Address: __________________________________ | e-mail: _____________________________ |
| City: _____________________________________ | |
| State: ___________ Zip: ______________________ |
RELEASE FROM LIABILITY
I have read and understand the safety requirements for visits to Glacier Peak Mines which include topaz and amazonite mining claims.
I understand visiting Glacier Peak Mining LLC, Colorado Calumet Co. Inc., and/or Crystaljack LLC mining properties and claims is inherently dangerous and that there are hazards associated with visiting any of these properties. I understand hazards include natural hazards such as lightning, high winds, falling trees, and adverse weather. I understand hazards associated with mining include (but are not all inclusive) falling rocks, collapsing pit walls, mechanized machinery movement, high-pressure line failure, explosives and resulting flying debris, fire, and other actions by other personnel. I understand other hazards include tripping and falling, and possibly injury using tools to extract and collect mineral specimens. By signing this release, I acknowledge these hazards and dangers which can result in injury, loss of limb, or even death and agree to release Glacier Peak Mining LLC, Colorado Calumet Co. Inc., Crystaljack LLC, and its employees and associates from any and all liabilities.
I agree to abide by and follow the safety instructions I receive by any employee or manager of Glacier Peak Mining LLC, Colorado Calumet Co. Inc., and/or Crystaljack LLC. I agree not to enter any site without specific permission to do so. I agree not to operate any equipment without specific instruction and permission. I agree to wear approved safety equipment and to follow all safety orders immediately. In particular, I will remain a safe distance from all highwalls and not collect within 8 feet of them unless cleared specifically to do so. I will maintain a safe distance from all persons using tools, to include shovels and picks and notify the person if I am about to come into their operating space. I will not enter a person's operating space without first notifying them and receiving permission. I will look behind me and in the direction of flight before tossing any rocks or rubble from my work area. I will always wear a hard hat whenever within the vicinity of a highwall and operational mechanized equipment. If allowed to be within the vicinity of mechanized equipment, including pneumatic tools, I will also wear appropriate ear, eye, and lung protection. I will not leave tools as to cause a tripping hazard, and I will account for all my tools and any tools loaned to me.
I agree that I will immediately return to the mining headquarters area (the tent or cars) upon hearing three long blasts on a whistle or horn.
I will dig in only designated areas and fill all holes unless specifically instructed not to do so. I will park in designated areas. I will report all finds to Glacier Peak personnel. I understand the minerals I find are the property of Glacier Peak Mining. Glacier Peak Mining may or may not offer to sell me specimens or they may or may not give me specimens which I find.
| Date ___________________ | |||
| _____________________________________ | _____________________________________ | ||
| Signature | Parent or Guardian Signature if under 18 | ||
| _____________________________________ | ______________________________________ | ||
| Printed Name | Printed Name | ||
| ______________________________________ | |||
| Child's Name |