Waiver Release of liability

NATIONAL SPORTS ENTERTAINMENT & RECREATION ASSOCIATION
Industry Insurance Programs 􀁺 www.nsera.com/paintball
Action Center LLC = AC Phone: (801) 876-3132
READ CAREFULLY
WAIVER AND RELEASE OF LIABILITY
In consideration of AC 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 AC; 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 AC, 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 AC 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 AC. This waiver is good through 5/8/2011.
MEDICAL PERMISSION AUTHORIZATION
If the participant is of minority age, the undersigned parent or guardian hereby gives
permission for AC 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 AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO
EXEMPT AND RELIEVE AC FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL
DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.
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Print Name Age Date of Birth Phone
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Signature Address City, State Zip
 

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Signature of Parent/Guardian (if less than 18 years old) E-mail

Date: _________________________________________