Name *

First Name

Last Name

Date of Birth (must be at least 18 years of age) *

MM

DD

YYYY

Select the first day of your mining access (starts at noon) *

MM

DD

YYYY

Claim Waiver *

By checking this box, I acknowledge and accept the risks of recreational prospecting and agree to comply with all terms and legal requirements for access to all mining claims owned by Shane Klesh. I release Shane Klesh and affiliates from liability for injury or damages arising from my use. Permit is invalid without proof of payment. No access will be granted without a confirmed receipt.