Release Form
Name:
_____________________________________ _______________________________________
(Last) (First)
Address:
________________________________________________________________
(Street)
_______________________________________ __________ _________________
(City) (State) (Zip)
Home Phone #: __________________________ Cell Phone #:____________________________
Email Address:
____________ _______________ _____________________________________________
Age: Gender: email Address:
Any Allergies or physical disabilities? Yes No
If so, what:
Emergency Contact Information
Name:__________________________Contact Number: _________________________
I fully understand and acknowledge that; (a.) risks and dangers may exist in my use of paintball equipment and my
participation in paintball activities and other activity: (b.) my participation in such activities and/or use of such
equipment may result in my injury or illness that could cause serious disability; (c.) this is open field play and referee
may not be provided (d.) by my participation in these activities and/or use of equipment, I hereby assume all risks and
all responsibility for any losses and/or damages, whether caused in whole or in part by the negligence of others
conduct or of the staff, volunteers , officers, or employees of Living Waters, or by any other person. (e.) I voluntarily
agree to release, Living Waters staff, volunteers, officers, and employees from any and all claims or actions due to
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 activities. This waiver is good until rescinded in writing. I also give full permission to
use statements, pictures, and recordings of myself for promotional purposes.
MEDICAL PERMISSION AUTHORIZATION:
If the participant is of minority age, the undersigned parent or guardian hereby gives permission to Living Waters to
authorize emergency medical treatment as may be deemed necessary for the child named below.
Signature: Date:
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Signature: Date:
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(Parent signs here if participant is under the age of 18)