Gloucester Recreational Park
2735 George Washington Memorial Highway, Hayes, Virginia 23072

In consideration of Gloucester. Recreational Park Inc. (GRP) furnishing services and/or equipment that enable me to participate in The Swamp paintball games, I agree as follows: I fully understand and acknowledge that

a. risks and dangers exist in my participation of such activities and/or personal use of such equipment may result in my injury or illness (including but not limited to bodily injury, disease, strains, fractures, partial or total paralysis, eye injury, blindness, heart stroke, heart attack, other ailments that could cause serious illness or disability and in severe cases death.)
b. the risks mentioned above that can cause danger to my person may be caused by the negligence of the owner, employees, officers or agents.of GRP, the negligence of participants and others on public grounds, accidents, breathes of contract, and/or predictable or unpredictable forces of nature such as heavy precipitation, storms, unforeseeable forces, acts of god, inconvenient weather, or natural disasters.
c. by my participation in these activities and/or personal use of equipment, I hereby assume and accept full responsibility for the injuries, Illnesses, and/or other inconveniences that are inflicted on myself due to these risks and dangers and will not hold the owner, employees, or officers of GRP reliable for my accidents.

I, on behalf of myself, my personal representatives and my heirs, I hereby voluntarily agree to release, waive, discharge, and defend.GRP , its owners, agents, officers, and employees from any and all claims of bodily injury, property damage, fatal Illness, loss of property and/or services, death, or otherwise • circumstances which may arise out of my participation In activities and/or personal use of equipment here at The Swamp Paintball Park. I also understand that any images captured on public grounds of The Swamp Paintball Park may be used for advertisement and/or promotional purposes via social media and personal emails given on waiver may be used to distribute promotional notifications. This legally binding, waiver is good from January 1st, 2017 through December 31st, 2017. 

I Have Read The Above Waiver And Release Form And By Signing It, I Agree That It Is My Intention To Exempt And Relieve GRP From Legal Liability For Personal Injury, Property . Damage, And/Or Wrongful Death Caused By Negligence Or Any Other Cause. 

Date: July 16, 2024

Please select who will be participating...
First Participant's Name

First Name*

Last Name*

First Participant's Date of Birth*
First Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Parent or Guardian's Email Address

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A signed copy of this waiver will be sent to the email address you provide.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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