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NATIONAL SPORTS ENTERTAINMENT & RECREATION ASSOCIATION

& Pentagon Paintball, Inc.
Industry Insurance Programs

No matter where you play, always ask and verify field insurance.

www.nsera.com/paintball

Pentagon Legal Stuff. Read Before Signing.
READ CAREFULLY
WAIVER AND RELEASE OF LIABILITY for Pentagon Paintball.
In consideration of Pentagon Paintball 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; 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 arise from 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, 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 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.

MEDICAL PERMISSION AUTHORIZATION
If the participant is of minority age, the undersigned parent or guardian hereby gives permission for Pentagon Paintball 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 FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

Print Name _______________________________________________

Age __ ______Date of Birth _____________Phone______________

Signature ________________________________________________

Address _________________________________________________

City ________________________State_______ Zip_____________

Signature of Parent/Guardian _____________________________

(if less than 18 yrs old)

E-mail __________________________________________________

DATE _______________________