PAINTBALL BUSINESS ASSOCIATION
INDUSTRY INSURANCE PROGRAMS . www.sera.com/paintball
RM=Real McCoy Paintball 919-936-2025
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WAIVER AND RELEASE OF LIABILITY
In consideration of RM 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 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 RM.; 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 RM, 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 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 Real McCoy Paintball field. This waiver is good till 03-1-12
MEDICAL PERMISSION AUTHORIZATION
If the participant is of minority age, the undersigned parent or guardian hereby gives permission for RMP to
authorize emergency medical treatment as may be deemed necessary for the child named below while participating in paintball games
from the date through 03-01-12
I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE Real McCoy Paintball (James McCoy) FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.
____________________________ ________ ____________ ________________ _______________
SIGNATURE of player AGE DATE OF BIRTH PHONE DATE
PRINT NAME__________________________________ EMAIL___________________________________________
ADDRESS_________________________________________________________________________________________________________________
CITY STATE ZIP Signature of parent or gurdian if under 18 years of age
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