SPECIALTY INSURANCE LLC
Industry Insurance Programs
Paintball To Go Inc. = PTG
Phone: (217) 589-5673
RELEASE OF LIABILITY, INDEMNITY AND ASSUMPTION OF RISK
READ BEFORE SIGNING
IN CONSIDERATION of being permitted to participate in any Paintball activities including, but
not limited to, playing, using the premises of, renting and operating equipment leased, sanctioned
and/or operated by the above named vendor, I acknowledge and agree that:
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 strains, 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 PTG; 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 PTG, 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 indemnify PTG and it’s owners, agents, officers
and employees from any and all claims, actions or losses for bodily injury, property damage
(including, but not limited to, arising out of the actual or alleged transmission of a communicable
disease), 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 conduct by the owners, agents, officers or employees of PTG. This waiver is
good through 8/1/2023.
MEDICAL PERMISSION AUTHORIZATION
If the participant is of minority age, the undersigned parent or guardian hereby gives
permission for PTG to authorize emergency medical treatment as may be deemed necessary for the
child named below while participating in Paintball games.
I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO
EXEMPT AND RELIEVE PTG FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL
DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.
__________________________________ __________ ________________ ________________________
Print Name Age Date of Birth Phone
__________________________________ ____________________________ ________________________
Signature Address City, State Zip
______________________________________________ __________________________________________
Signature of Parent/Guardian (if less than 18 years old) E-mail
Date: ___________________________________