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Cossio Insurance Agency P.O. Box 1304 Fountain Inn, SC 29644 Phone: (864) 862-2838 Fax: (801) 640-9298 |
FOX 4 Paintball 159 Milford Street Upton, MA 01568 Phone: (508) 529-3694 |
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SCENARIO/BIG GAME 2004 In consideration of FOX 4 Paintball furnishing services and / or
equipment to enable me to participate in paintball games,
I, on behalf of myself, my personal representatives and my heirs, hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnity FOX 4 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 conducts by the owners, agents officers or employees of FOX 4 Paintball, THIS WAIVER IS GOOD THROUGH 12/31/2004 I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE FOX 4 PAINTBALL FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE. PARTICIPANTS SIGNATURE:
SIGNATURE OF PARENT (If participant is < 18 years of age):
NAME: _________________________________ AGE: ________
STREET ADDRESS: ____________________________________
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CIRCLE THE SCENARIO
Interested in a Scenario Role? General / Bazooka
Team / Medic / Engineer /
Demo Expert CIRCLE THE PRICES FOR THE OPTIONS YOU WANT I am Renting* One Scenario $ 60
*RENTAL PACKAGE: SEMI-AUTO
PAINTBALL GUN, FULL FACE MASK, AMMO BELT, AIR AND 500 PAINTBALLS. One Scenario $ 45 I Have a GOLD PASS One Scenario $ 20 Team preference Allies or Axis
FORFEITS:
Anyone who fails to show up forfeits his registration fee. No refunds will
be given.
MAJOR CREDIT CARDS
Card: VISA M/C AMEX Card
Number:
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