Name:                                                                                                                         

                        (Last)                                                   (First)

 

Address:                                                                                                                                  

                        (Street)                        

            

                                                                                                                                               

                        (City)                                                   (State)                          (Zip)

 

Age:                     Gender:                                Years of Experience:                

                                                                                    (Paintball)

 

Home Phone #: (       )                               Cell Phone #: (      )            

 

Email Address:                                                                                                                        

 

Allergies and Medications

 

Any Allergies or physical disabilities?           Yes   No   

 

If so, what:                                                                                                                  

 

Emergency Contact Information

 

Name:______________________________

 

Contact Number: (      )                                  

 

 

Package Option (Please Check One)   Full Package              Day Package          Overnight Pack.        

Payment Option( Please Check One)  Cash              Check          Check #             

Liability Waiver

   

I fully understand and acknowledge that; (a.) risks and dangers may 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 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 paintball activities. This waiver is good until rescinded in writing.

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:                           

 

Signature:                                                                                              Date:                           

(Parent signs here if participant is under the age of 18)