Powerline Paintball

Waiver and Medical Release Forms

Home
Pictures
About Us
2013 Season Play Fees
Map/Directions
Waiver and Medical Release Forms
Contact Us

WAIVER

Powerline Piantball

2698 Poplar RoadStafford, Va. 22406

http://www.powerlinepaintball.net

Waiver and Release of Liability 

Paintball Business Insurance 155 Verdin Rd Greenville SC 29607 Phone: 864-297-9727

In consideration of Powerline Paintball 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 Powerline Paintball; the negligence of the participants, the negligence of others, accidents, breaches of contact, the forces of nature or other 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 or the owners, agents, officers, employees of Powerline Paintball , 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 Powerline Paintball 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 Powerline Paintball. This waiver is good until December 31st, 2013.  

I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE POWERLINE PAINTBALL FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

Name (First & Last):

Age:

DOB:

Address:

City:

State:

Zip:

Phone:

Signature:

Date:

If under the age of 18, please have your Parent or Legal Guardian fill out the section below: Parent/Guardian Name:

Address:

City:

Phone Number:

                               State:                       Zip:
Signature:                                Date:  

 

2698 Poplar Road * Fredricksburg * VA * 22406 Phone: (540) 286-0404 Cell: (540) 270-8478 for VM please use cell or email to powerlinep@aol.com

Powered by Register.com