To Print Word Doc. click here Waiver Form for Pentagon

NATIONAL SPORTS ENTERTAINMENT & RECREATION ASSOCIATION

Industry Insurance Programs ?? www.nsera.com/paintball

READ CAREFULLY

WAIVER AND RELEASE OF LIABILITY

In consideration of Pentagon Paintball, Inc. furnishing services and /or equipment to enable me to participate in

paintball games, I agree as follows:

I fully understand and acknowledge that; (a) risks and dangers exist in my use of Paintball equipment

and my participation in Paintball activities; (b) my participation in such activities and/or use of such

equipment may result in my injury or illness including but not limited to bodily injury, disease strains, fractures,

partial and/or total paralysis, eye injury, blindness, heat stroke, heart attack, death or other ailments that could

cause serious disability; (c) these risks and dangers may be caused by the negligence of the owners,

employees, officers or agents of Pentagon Paintball, Inc. ; the negligence of the participants, the negligence of others,accidents, breaches of contract, the forces of nature or other causes. These risks and dangers may arisefrom foreseeable or unforeseeable causes; and (d) by my participation in these activities and/or use of

equipment, I hereby assume all risks and dangers and all responsibility for any losses and/or damages,

whether caused in whole or in part by the negligence or other conduct of the owners, agents, officers,

employees of Pentagon Paintball, Inc. , or by any other person.

I, on behalf of myself, my personal representatives and my heirs, hereby voluntarily agree to release,

waive, discharge, hold harmless, defend and indemnify Pentagon Paintball, Inc. and it’s owners, agents, officers and employees from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my use of Paintball equipment or my participation in Paintball activities. I specifically understand that I am releasing, discharging and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the owners, agents, officers or employees of Pentagon Paintball, Inc. . This waiver is good through 12/12/08 .

MEDICAL PERMISSION AUTHORIZATION

If the participant is of minority age, the undersigned parent or guardian hereby gives permission for

Pentagon Paintball, Inc. to authorize emergency medical treatment as may be deemed necessary for the child named below while participating in paintball games from this date through 12/12/08 .

I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE Pentagon Paintball, Inc. FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

Print Name ________________________Age Date of Birth__________ Phone______________

Player Signature _______________________________________

Address  ________________________________City____________, State ____Zip ___________

Signature of Parent/Guardian ______________________ E-mail ___________________________

(if less than 18 yrs old)

DATE_________________________

If you have any question Please call Sean or Nicole at Pentagon Paintball, Inc. at 814-474-5580.