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Paintball & Airsoft Indiana Wavier

SPECIALTY INSURANCE LLC

Industry Insurance Programs

Paintball Indiana = PBI

Phone: (317) 796-1191

 April 27, 2024

RELEASE OF LIABILITY, INDEMNITY AND ASSUMPTION OF RISK

 

READ BEFORE SIGNING

 

IN CONSIDERATION of being permitted to participate in any Paintball and/or Gellyball and/or Airsoft activities

including, but not limited to, playing, using the premises of, renting and operating equipment leased,

sanctioned and/or operated by the above named vendor, I acknowledge and agree that:

I fully understand and acknowledge that; (a) risks and dangers exist in my use of Paintball

and/or Gellyball and Airsoft equipment and my participation in Paintball and/or Gellyball activities and or Airsoft; (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 PBI; 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 PBI, 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 PBI and it’s owners, agents, officers

and employees from any and all claims, actions or losses for bodily injury, property damage

(including, but not limited to, arising out of the actual or alleged transmission of a communicable

disease), wrongful death, loss of services or otherwise which may arise out of my use of Paintball

and/or Gellyball equipment or my participation in Paintball and/or Gellyball and/or Airsoft 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 PBI. This Waiver is good through 3/4/2024.

 

MEDICAL PERMISSION AUTHORIZATION

 

If the participant is of minority age, the undersigned parent or guardian hereby gives

permission for PBI to authorize emergency medical treatment as may be deemed necessary for the

child named below while participating in Paintball and/or Gellyball and/or Airsoft games.

I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO

EXEMPT AND RELIEVE PBI FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL

DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

I Agree

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
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*

Middle Name

Last Name*

Phone*
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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