Commander / Webmaster - 1^st Lt. Scott Varga

Recruit info - Dave Strichko

I,__________________________________, Certify that I am the parent/legal guardian of _________________________________.

By signing below, I agree that the 5^th Independent company of Ohio Sharp Shooters / 3^rd Battalion Georgia Sharpshooters are not responsible in any way for the minor listed above. I agree that if medical assistance is needed, while the minor is at a 5^th Ind. Co. O.S.S / 3^rd Batt. G.S.S event, that the 5^th Ind. Co. O.S.S. / 3^rd Batt. G.S.S. will assist in seeking the proper authorities to administer assistance. I understand that the 5^th Ind. Co. O.S.S / 3^rd Batt. G.S.S will not be responsible for any charges that medical assistance may incur. I consent to the participation of the minor listed above as a member of the 5^th Ind. Co. O.S.S. / 3^rd Batt. G.S.S. and will follow the rules of the group that are in place during all 5^th Ind. Co. O.S.S. / 3^rd Batt. G.S.S. activities.

Signature______________________________________ Date__________

Printed________________________________________ Date__________

Mail to: David Strichko

12287 Woodiebrook Rd

Chardon, Ohio 44024