This release is to be considered permission for storyteller, Andy Cheney, to present a Living History program in the facilities of

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on ____________________________ , 20 ____.

I acknowledge that said program may involve the possession and display of period accoutrements, including but not limited to: reproduction musket, belt axe, tomahawk, bayonet, knife, demonstration cartirdges and lead roundball ammunition. NO Black Powder or other propellants will be present at demonstration. All such items shall remain under the control of Mr. Cheney at all times.

There will be no 'live' cartridges or weapons being discharged without separate and specific permission. It is understood that any item to be handled by students or any member of the audience will be inert and age appropriate. NO edged weapons will be handled by students or audience.

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Principal/Authorized Person / Date

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Classroom Teacher / Date

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Police Dept. Representative / Date