FlagRunner® Paintball Charity Club (FPCC)
Jason T. Black,
President: (814) 882-1407
JR Walters, VP: (814)
720-8712
READ CAREFULLY
WAIVER
In consideration of
FlagRunner® Paintball Charity Club, hereafter referred to as FPCC, 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, officers or agents of
FPCC; 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 FPCC, 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 FPCC and
it’s owners, agents, officers, employees and affiliates 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 or officers of FPCC. This waiver is good through
12/31/2012.
MEDICAL PERMISSION
AUTHORIZATION
If the participant is
of minority age, the undersigned parent or guardian hereby gives permission for
FPCC to authorize emergency medical treatment as may be deemed necessary for
the child named below while participating in paintball games.
I HAVE READ THE ABOVE
WAIVER
____________________________ __________ _______________ ________________
Print Name Age
Date
of Birth Phone
____________________________ ___________________________ _____________________________
Signature Address
City,
State, Zip
______________________________
__________________________________________
Signature
of Parent/Guardian (if less than 18 years
old)
____________________________ ____________________________
Date Email