MEDICAL PERMISSION FORM

The undersigned parent or guardian hereby gives permission for:________________________________

to authorize emergency medical treatment as may be deemed necessary for the child named below, while playing paintball games at ____________________________

from this date ____________________ thru year end.

____________________________________________________

NAME OF MINOR AGED PLAYER

________________________________________________________________

ADDRESS

____________________________________

CITY, STATE ZIP

____________________________________

TELEPHONE

____________________________________

SIGNATURE OF PARENT OR GUARDIAN

_______________________________________________________________

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