NAME: _______________________________________________________ DATE: _____________________________________
                                               (PLEASE PRINT)
ADDRESS: ______________________________________________________ PHONE: _______________________________

CITY: __________________________________STATE_______ZIP_________ EM. CONTACT: __________________________

READ CAREFULLY: WAIVER AND RELEASE OF LIABILITY IN CONSIDERATION OF FIELD FURNISHING SERVICES AND/ OR EQUIPMENT TO ENABLE ME TO PARTICIPATE IN PAINTBALL GAMES AT JACO’S PAINTBALL LAIR, I AGREE AS FOLLOWS:

I FULLY UNDERSTAND AND ACKNOWLEDGE THAT RISKS AND DANGERS EXIST IN MY USE OF PAINTBALL EQUIPMENT AND PARTICIPATION IN PAINTBALL ACTIVITIES; THAT MY PARTICIPATION IN SUCH ACTIVITIES AND/ OR USE OF SUCH EQUIPMENT MAY RESULT IN MY 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; THESE RISKS AND DANGERS MAY BE CAUSED BY THE NEGLIGENCE OF THE OWNERS, EMPLOYEES, OFFICERS OR AGENTS OF FIELDTHE NEGLIGENCE OF THE PARTICIPANTS, THE NEGLIGENCE OF OTHERS, ACCIDENTS, BREACHES OF CONTRACT, THE FORCES OF NATURE OR OTHER CAUSES. THESE RISKS AND DANGERS MAY ARRISE FROM FORESEEABLE OR UNFORESEEABLE CAUSES; AND 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 ABOVE SAID FIELD, OR BY ANY OTHER PERSON. I FURTHER WARRANT THAT I HAVE NO MEDICAL CONDITIONS AT THIS TIME THAT MIGHT CONTRIBUTE TO ANY OF THE ABOVE SAID CONDITIONS OR OTHERS UNNAMED. I CONMIRM THAT I AM IN GOOD PHYSICAL HEALTH AND AM PHYSICALLY FIT TO PLAY THIS HIGHLY ACTIVE SPORT.

I, ON BEHALF OF MYSELF, MY PERSONAL REPRESENTATIVES AND MY HEIRS, HEREBY VOLUNTARILY AGREE TO RELEASE, WAIVE, DISCHARGE, HOLD HARMLESS, DEFEND AND INDEMNIFY JACO’S PAINTBALL LAIR 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 JACO’S PAINTBALL LAIR.

I HAVE READ AND UNDERSTAND THE ABOVE WAIVER AND RELEASE. I UNDERSTAND THAT BY SIGNING THIS WAIVER AND RELEASE WITHOUT COUERSEMENT OR FORCE, I AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE JACO’S PAINTBALL LAIR, ITS OWNER, AGENTS, OFFICERS AND EMPLOYEES FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

                                                                                                   
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                                                     SIGNATURE OF PARENT OR GUARDIAN (IF LESS THAN 18 YRS OLD)