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03-02-2004, 07:17 PM

Parental Consent, Waiver, General Release and
Indemnification Agreement
The undersigned custodial parent(s) and/or legal guardian of ____________________, currently of
_______________________________________ [Street Address, City, State, Zip], (___) ___-____, Date of
Birth ________________, Age _____, (herein the "Minor") hereby represents and warrants that he/she possesses
the full and absolute power and authority to execute for or on behalf of the Minor without further consent of any other party this
document and all attachments thereto. In the event the undersigned breaches such representation or warranty, or such warranty is
untrue in any respect, the undersigned hereby accepts liability for indemnifying Paint Ball Sam's American War Games, Inc., to the
full extent provided hereafter.
It is the desire of the Minor to participate in paintball activities* now and in the future at the facility operated by Paint Ball
Sam's American War Games, Inc. (herein "Paint Ball Sam's"). As a custodial parent and/or legal guardian of the Minor, I consent to
the Minor's participation in paintball activities at Paint Ball Sam's present facility and any other facility operated by Paint Ball Sam in
the future (herein the "Field"). My consent shall be effective to permit the Minor to fully participate in paintball activities sponsored
by Paint Ball Sam's until such time as my consent is revoked by delivery to and receipt by Paint Ball Sam's of the written Revocation
attached hereto as Exhibit A.
The custodial parent(s) and/or legal guardian whose signature(s) appears on this consent, waiver, general release and
indemnification agreement (herein "Consent Form"), has reviewed material regarding paintball activities and is familiar with the
nature of the sport and the associated risks. ASSOCIATED RISKS MAY INCLUDE, BY WAY OF EXAMPLE AND NOT
LIMITATION, CONTUSIONS, BRUISES, SPRAINS, TORN LIGAMENTS, BROKEN BONES, DISABILITIES, LOSS OF EYE
SIGHT OR OTHER EYE INJURIES, INTERNAL INJURIES AND POSSIBLY DEATH. It is understood that the Minor will
participate in paintball activities with persons of all ages, sexes, races, nationalities and ethnic groups without discrimination. It is
understood that the Minor will be required to sign an Agreement and Waiver in substantially the form attached here as Exhibit B and
incorporated herein each time the Minor desires to participate in any paintball activities held at the Field or sponsored by Paint Ball
Sam's at any other location. By my signature affixed hereto, I hereby ratify and adopt each Agreement and Waiver executed by the
Minor prior to revocation of this consent form.
In consideration of Paint Ball Sam's agreement to permit the Minor to engage in paintball activities, I/we on behalf of the
Minor, myself/ourselves, and our respective heirs, personal representatives, executors, successors and assigns and any and all persons,
firms, corporations and/or other entities having rights or claims by way of derivation from or subrogation to myself/ourselves or the
Minor hereby release and remise and forever discharge Paint Ball Sam's, it successors and assigns and any and all persons, firms,
corporations and/or other entities having rights or liabilities by way of derivation from or subrogation to them including specifically
their lessor, employees, agents, servants, partners, members, officers, directors and shareholders as the case may be, and each of them,
of and from any and all claims, demands, rights or causes of action of whatsoever kind or nature, whether arising out of negligence,
strict liability in tort, breach of warranty or any other basis or claim, which the undersigned or the Minor has ever had or may now
have or may hereafter have, whether now known or unknown, foreseen or unforeseen, including all developments and results
therefrom, whether developed or undeveloped, and anticipated or unanticipated consequences arising from or by reason of or in any
way connected with, any injuries, losses, damages, disability, suffering, property damage or loss, or the result thereof, which
heretofore have been or hereafter may be sustained by the Minor as a result of or in connection with the Minor's arriving at, departing
from or occupying the Field or any other premises at which Minor is in attendance, spectating, participating or otherwise relative to
paintball activities, and to indemnify, defend and hold Paint Ball Sam's harmless of and from all of the foregoing.
2
It is required that the custodial parent(s) and/or legal guardian whose name(s) appears on the consent form execute this
document in the presence of an authorized representative of Paint Ball Sam's or in the presence of a notary.
It is understood by the custodial parent(s) and/or legal guardian, whose signature appears on the consent form, that these
documents are fully intended to be and are general and absolute releases.
IF THE CUSTODIAL PARENT(S) AND/OR LEGAL GUARDIAN WHOSE SIGNATURE APPEARS ON THE
CONSENT FORM POSSESS ANY DOUBTS WHATSOEVER ABOUT THE MINOR PARTICIPATING IN PAINTBALL
ACTIVITIES, DO NOT SIGN THE CONSENT FORM.
Only persons under the age of majority that have attained the age of at least fourteen (14) years of age and possess a valid
picture identification shall be allowed to participate in paintball activities at the Field, the Minor must present Paint Ball Sam’s
Minor’s picture identification each time the Minor desires to participate in any paintball activities held at the Field or sponsored by
Paintball Sam’s at any other location. To verify that the Minor is at least fourteen (14) years of age, the custodial parent(s) and/or
legal guardian shall provide Paint Ball Sam’s with a copy of the Minor’s birth certificate accompanying this fully executed Consent
Form to be maintained by Paintball Sam’s unless the valid picture identification presented by the Minor each time the Minor
participates in paintball activities at the field or sponsored by Paintball Sam’s at any other location verifies the Minor’s age. If the
custodial parent(s) and/or legal guardian fail, refuse or otherwise do not provide Paintball Sam’s with a copy of the Minor’s birth
certificate, the custodial parent(s) and/or legal guardian represent and warrant the Minor has attained at least the age of fourteen (14)
and assume all liability if such representation and warranty is fake.
The undersigned custodial parent(s) and/or legal guardian have read and understand the consent form and all attachments by
this statement, are advised to have legal counsel review the consent form and all attachments. Whether or not such advice was
followed, I/we agree to the provisions set forth in the consent form and all attachments.
* Paintball Activities means participating, engaging, spectating or otherwise in paintball games at the Field; participating,
engaging, spectating or otherwise in any and all activities that occur on the target range at the Field; participating,
engaging, spectating or otherwise in any and all uses of paintball equipment at the Field.
Custodial Parent(s) and/or Legal Guardian
Dated:
(Print Name)
Dated:
(Print Name)
WITNESSED:
Subscribed and sworn to before me this
____ day of _____________, 20____.
____________________________________
OR Authorized Representative of Paint Ball
Sam's
______________________ (Print Name)
Notary Public, State of Wisconsin ____________________________________
My Commission:____________________ (Printed Name of Witness)
3
Medical Permission Form
The undersigned parent(s) and/or legal guardian of________________________________________________ __
[Print Name]
currently of________________________________________________ __________________________________
[Street Address, City, State, Zip]
(_______)______-__________________ ______________ ________________ (herein the ‘Minor”),
[Phone Number] [Date of Birth] [Age]
authorizes emergency medical treatment as may be deemed necessary for the Minor while at the Field, as defined in the
Parental Consent, Waiver, General Release and Indemnification Agreement incorporated herein, for the date of the
Parental Consent, Waiver, General Release and Indemnification Agreement naming the Minor until Exibit A of such
document is delivered and received by PaintBall Sam’s as that term is defined in the Parental Consent, Waiver, General
Release and Indemnification.
Custodial Parent(s) and/or Legal Guardian
Signature:________________________________________ ______________Dated:_________________
Print Name______________________________________
Signature:________________________________________ ______________ Dated___________________
Print Name:______________________________________
Medical Insurance Policy Number________________________ Insurance Company_________________________

There is all that is on the form, but you are better off just getting acrobat reader.