Cossio Insurance Agency Party Equipment Rentals
Member Field No. :
Date of Birth:
First Time Played:
How many times do you play per year?
Effective date of coverage:
Daily or Annual Coverage:
1 Day - $5.00
Annual - $25.00
Recreational Activity Release of Liability, Waiver of Claims, Express Assumption Of Risk and Indemnity Agreement
Express Assumption of Risk Associated with Recreational Activities
I hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with the recreational activity generally described as Paintball/Airsoft/Laser Tag , including the rental of equipment and transportation associated therewith of which I am about to engage in. Inherent hazards and risks include but are not limited to:
1. Risk of injury from the activity and equipment utilized is significant including the potential for permanent disability and death.
2. Possible equipment failure and/or malfunction of my own or other’s equipment.
3. This activity takes place outdoors and therefore includes risks associated with exposure to elements, excessive heat, hypothermia, impact of the body upon the water, injection of water into my body orifices, encountering objects either natural or man-made, exposure to animals with the attendant risks of kicking, biting, shying away, running off or otherwise moving in an unanticipated manner causing injury and/or death.
4. My own negligence and/or the negligence of others, including but not limited to operator error and guide decision making including misjudging terrain, rapids, weather, trails, and route location.
5. Attack by or encounter with insects, reptiles, and/or animals.
6. Accidents or illness occurring in remote places where there are no available medical facilities.
7. Fatigue, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident.
*I Understand the description of these risks is not complete and that unknown or unanticipated risks may result in injury, illness, or death
Release of Liability, Waiver of Claims and Indemnity Agreement
In consideration for being permitted to participate in the activity(ies) described above the related activities, I hereby agree, acknowledge and appreciate that.
1. I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as releases.
2. To release the releasees, their officers, directors, employees, representatives, agents, and volunteers, and vessels from liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by active or passive negligence of the releases or otherwise. By executing this document, I agree to hold the releasees harmless and indemnify there in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of engaging in the above activities.
3. By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releases, other than what is set forth in this Agreement.
This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to unenforceable, the remaining terms shall be enforeced
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND I FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Signature of the Adult Participant:
Driver's License of Adult Participant:
For Participants of Minority Age, this is to clarify that I, as a Parent, Guardian, Temporary Guardian with legal responsibility for this participant, do consent and agree not only to his/her release of all releasees, but also to release and indemnify the Releasees from any and all liabilities incident to his/her involvement in these programs for myself, my heir, assigns, and next of kin.
The Legal Guardian's Name: First:
(Legal Guardian Signature if participant is a minor. They on my behalf release all claims that both they and I have)
Driver's License of Legal Guardian:
MEDICAL PERMISSION FORM
The undersigned parent or guardian hereby gives permission to authorize emergency medical treatment as may be deemed necessary for the child named below, while playing Paintball or Lasertag games at
(Paintball Field Name Here).
Legal Parent / Guardian's Signature:
Please make sure that you have completed everything to the best of your knowledge before going to the next page.