Dragon Blade War V Consensual Participation/ Medical Release Waiver

Mundane (real) Name: ______________________________________________________

Persona Name: ___________________________________________________________

Address: ________________________________________________________________

City:  _________________________  State:  _____________________  Zip: __________

Farspeaker (Phone) Number: (_____) ______- __________

Your date of birth: ____/____/_______

Astral Location (email address): ________________________________________________

Home Chapter:  ____________________  Home Kingdom: __________________________

I agree to release and hold harmless Amtgard, Inc., The Empire of the Iron Mountains, The Principality of Desert Winds, The Duchy of the Desert Rose, Amtgard splinter group chapters, the Owners of Welcome RV Park and all members of all Amtgard Chapters from and against all claims, demands, and actions in respect to damage to my person or my property arising in connection with my participation in Dragon Blade War V. Furthermore, I accept and understand that neither Amtgard nor any Amtgard members are responsible for any injuries received or given at this or any Amtgard function. I further understand that, as with any physical sport, participation in Amtgard has an element of risk. I also authorize by my signature herein permission for medical treatment by professional means, if necessary, and I am unable to answer for myself. Breaking of mundane laws, including but not limited to; theft, assault, sexual assault, sexual harassment, underage drinking, contributing to the delinquency of a minor, or the use of Illegal drugs WILL NOT BE TOLERATED! And will be reported to the appropriate mundane authorities in addition to the Judgements and Actions specified in the Amtgard Rules of Play and the Corpora of the Iron Mountains. Grievances should be brought to the attention of the Desert Rose Monarchy and/or the Dragon Blade Wars Autocrat. Note: Anyone under the age of 14 may only participate in fighting activities with the permission of their Parents/Guardians and the Monarch and/or Guildmaster of Reeves.