MEDICAL PERMISSION FORM

(for Players aged 10-17)

The undersigned parent or guardian hereby gives permission to Blue Ridge Paintball Park to authorize emergency medical treatment as may be deemed necessary for the child named below, while playing paintball games at Blue Ridge Paintball Park from this DATE: ___________________ through one year hence.

______________________________________

Name of Minor Aged Player

____________________________________________

Address

____________________________________________

City                                      State               Zip

______________________________
Telephone

X ___________________________________________

PARENT OR GUARDIAN SIGNATURE

_____________________________________________

Print Name of Parent/Guardian

_____________________________________________________________________________
Medical Insurance Policy Number                          Insurance Company

In addition to this form, the RELEASE OF LIABILITY form must be signed by a parent or guardian.