ADDRESS _______________________________________________________________________________

CITY __________________________________________ STATE ______________ ZIP ________________

PHONE __________________________ E-MAIL ADDRESS _______________________________________

DATE ________________________ TEAM NAME ______________________________________________

     KNOW ALL MEN BY THESE PRESENT THAT THE UNDERSIGNED, being of lawful age, for the sole consideration of being granted the opportunity to participate in the below described event does hereby and for his/her heirs, executors, administrators, personal representatives, successors and assigns release, acquit and forever discharge in the United States of America and the Owner of any lands utilized by Wayne Dollack, Jacqueline Dollack, Wayne Dollack 24 Hour Role-Playing Scenario Games, Inc. or Wayne's World of Paintball, Inc. in the conduct of its operations and its or their agents, servants, successors, personal representatives, heirs, executors, administrators, assigns, and all other persons, firms, corporations, associations, or partnerships of and from any and all claims, actions, causes of action, demands, rights, damages, costs, loss of service, expenses and compensation whatsoever, which the undersigned now has or which may hereafter accrue or result from on account of or in any growing out of any and all known and unknown, foreseen and unforeseen, bodily and personal injuries and property damage and the consequences thereof resulting or to result or which may result from any accident, casualty or event which may or did occur for any reason in connection with or arising out of or on account of the undersigned's participation in simulated combat situations, whether as contestant or observer, held on the date of execution hereof.
     It is understood and agreed that this release is made in order to induce Wayne Dollack, Jacqueline Dollack,  Wayne Dollack 24 Hour Role-Playing Scenario Games, Inc. or Wayne's World of Paintball, Inc. and Scenario Directors to allow the undersigned to participate in the event herein referenced and that such inducement is material to Wayne Dollack, Jacqueline Dollack, Wayne Dollack 24 Hour Role-Playing Scenario Games, Inc. or Wayne's World of Paintball, Inc. decision to allow the undersigned to so participate. Furthermore, the undersigned agrees to follow and abide by the letter and spirit of the rules of safety and play as defined by Wayne Dollack, Jacqueline Dollack, Wayne Dollack 24 Hour Role-Playing Scenario Games, Inc. or Wayne's World of Paintball, Inc.  and/or its representatives. Specifically, the undersigned agrees to wear at all times while on the playing field eye protection approved by Wayne Dollack, Jacqueline Dollack, Wayne Dollack 24 Hour Role-Playing Scenario Games, Inc. or Wayne's World of Paintball, Inc. and/or its representatives.
     The undersigned hereby declares and represents that he/she acknowledges and understands that any injuries which may be sustained for any reason may be permanent and progressive and that recovery therefrom is uncertain and indefinite, or may be fatal, and in making this Release it is understood and agreed that the undersigned intends to assume any and all risks of loss, including property damage losses, and indemnifies and saves Wayne Dollack, Jacqueline Dollack, Wayne Dollack 24 Hour Role-Playing Scenario Games, Inc. or Wayne's World of Paintball, Inc. and/or its representatives from any damage, loss, claim, cost, and expense of any kind or nature.
    The undersigned further declares and represents that no promise, inducement, or agreement not herein expressed has been made to the undersigned, and that this Release contains the entire agreement between the parties hereto, and that the terms of this Release are contractual and not a mere recital, and that it is made freely, knowingly and intentionally.
     The foregoing Release and its conditions are understood to apply to all other individual players, as well as Wayne Dollack, Jacqueline Dollack, Wayne Dollack 24 Hour Role-Playing Scenario Games, Inc. or Wayne's World of Paintball, Inc. and the land owners or Scenario Directors and Promoters of events.
     THE UNDERSIGNED HAS READ THE FOREGOING RELEASE AND FULLY UNDERSTANDS IT. THE UNDERSIGNED REPRESENTS THAT HE/SHE CAN READ AND WRITE THE ENGLISH LANGUAGE AND HAS SIGNED THIS RELEASE FREELY AND WITHOUT DURESS OR UNDER INFLUENCE OF ANY KIND.
THE UNDERSIGNED FURTHER ACKNOWLEDGES THAT THE EVENT ABOVE DESCRIBED MAY INVOLVE A HIGH DEGREE OF RISK OR PHYSICAL INJURY OR DEATH; THAT THE SIMULATED COMBAT SITUATIONS INVOLVE USE OF A GAS POWERED WEAPON SHOOTING PAINT-FILLED GELATIN PROJECTILES AND THAT IT IS HIGHLY PROBABLE THAT THE UNDERSIGNED WILL BE HIT BY ONE OR MORE SUCH PROJECTILES. In witness whereof I have hereunto set my hand and seal and delivered this Release the day referenced above.

SIGNATURE ___________________________________________________Date ____________________