MEDICAL PERSMISSION FORM

_____________________ to authorize emergency medical treatment as may be deemed necessary for the child named below, while playing paintball games at ____________________________________________ from this date __________________ through year-end.

NAME OF MINOR AGED PLAYER ____________________________________ ADDRESS ____________________________________
CITY, STATE, ZIP ____________________________________
TELEPHONE ____________________________________
SIGNATURE OF PARENT OR GUARDIAN ____________________________________ MEDICAL INSURANCE POLICY AND COMPANY ___________________________________