|
Bambi Bullard dba Coastal Paintball dba Phone: 910-347-4199 |
|||
|
READ
CAREFULLY
WAIVER AND RELEASE OF LIABILITY |
|||
|
In consideration of COPB furnishing 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 angers exist in my use of Paintball equipment and my participation in Paintball activities; (b) my participation in such activities and/or use of 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 COPB 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 in in part by the negligence or other conduct of the owners, agents, officers, employees of COPB, 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 COPB 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 COPB. This waiver is good until 3/08. I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE COPB FROM LIABILITY OR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE. |
|||
|
Print Name |
Age |
Date of Birth |
Phone |
|
Signature |
Address |
City, State, Zip |
|
|
Signature of Parent/Guardian (If less than 18 yrs old) |
|
||
|
DATE |
|||
| In consideration for using the paintball facilities located on Camp Lejeune MCB, NC, I hereby release the United States Government including all its subdivisions, officers, military personnel, employees and agents from all liability for any injuries or death that may result from this use, whether caused by negligence or otherwise _________________ Initials. | |||