MEDICAL PERMISSION FORM

The undersigned parent or guardian hereby gives permission for The War Club Paintball Park

to authorize emergency medical treatment as may be deemed necessary for the child named below, while playing paintball games at The War Club Paintball Park

from this date ____________________ thru year end.

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NAME OF MINOR AGED PLAYER

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ADDRESS

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CITY, STATE ZIP

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TELEPHONE

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SIGNATURE OF PARENT OR GUARDIAN

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MEDICAL INSURANCE POLICY NUMBER INSURANCE COMPANY

IN ADDITION TO THIS FORM, THE NATIONAL PAINTBALL ASSOCIATION WAIVER FORM #501 MUST BE SIGNED BY A PARENT OR GUARDIAN, AS WELL AS THE MINORITY AGE PLAYER