River Valley Paintball Games Inc.

River Valley Paintball Games

Medical Permission Form

This form is required for all players under age 18.

The undersigned parent or guardian hereby gives permission for:
River Valley Paintball Games or ________________________________
to authorize emergency medical treatment as may be deemed necessary for the child named below, while playing paintball games at River Valley Paintball.

From this date _____________thru year end ___________.

Name of Minor Aged Player:

_______________________________________________________________
(Print...Last Name) (First Name)

__________________________________________________________________
(Street Address) (City) (State) (Zipcode)

________________________________ _______________________________
(Home Telephone) (Emergency Telephone Contact)

_______________________________________
(Signature of Parent or Guardian)

_______________________________________
(Print Name)

____________________________________ _____________________________
(Medical Insurance Policy Number Insurance Company

List Allergies and/or Current Medical Treatments for
Emergency Medical Personel Only:

___________________________________________________________________

_________
(Age)

_________
(Weight)