I found this at:
http://www.cva.com/media/huntfacts4.htm
You can improve hunter/landowner relations by getting permission before hunting on any property. Approach the landowner with courtesy; you'll have a better chance of getting permission and you can promote the image of the responsible hunter. Use a written permission form when seeking access to hunt. For information on obtaining the NRA Hunter/Landowner's Permission Booklet contact the Hunter Services Dept. at (800) 492-HUNT.
here's a generic form that may be just what you're looking for.
http://thesouthernoutdoorsman.com/permission_form.htm