Cossio Insurance Agency
P.O. Box 1304
Fountain Inn, SC  29644
Phone: (864) 862-2838
Fax: (801) 640-9298

READ CAREFULLY
WAIVER AND RELEASE OF LIABILITY

In consideration of FOX 4 Paintball 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 dangers exist in my use of paintball equipment and my participation in paintball activities; (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, sprains, 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 FOX 4 Paintball; 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 FOX 4 Paintball 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 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.

X________________________________ Date: _______________
  PARTICIPANTS SIGNATURE:

X_________________________________ Date: ______________
SIGNATURE OF PARENT (If participant is < 18 years of age) 

FULL DAY                    $ 45

HALF DAY                    $30
10am-12:30pm
or
1pm-3:30pm

*RENTAL PACKAGE INCLUDES SEMI-AUTO PAINTBALL GUN, FULL FACE MASK, AMMO BELT, AIR AND 500 PAINTBALLS.

Field Fee*                   $ 25
* Includes All Day Air      

Other Items

Jump Suit or Shirt      $ 5

Additional Paint

500 Rounds                $ 20
1000 Rounds                $ 35
2000 Rounds                $ 60

--- Official Use Only ---

Discount (if any):______

Total:   ________