CIA The COSSIO INSURANCE AGENCY                                          Total Control Paintball LLC = TCP                                                                                      Phone: (574) 277 –  4493                                                                  READ CAREFULLY                                                   WAIVER AND RELEASE OF LIABILITY In consideration of TCP furnishing services and/or equipment to enable me to participate in PAINTBALL games, I agree as follows: I fully understand and acknowledge that; (a) risks and dangers exist in my use of PAINTBALL equipment and my participation in PAINTBALL activities; (b) my participation in such activities and/or use of such equipment may result in my injury or illness including but not limited to bodily injury, disease strains, fractures, partial and/or total paralysis, eye injury, blindness, heat stroke, heart attack, death or other ailments that could cause serious disability; (c) these risks and dangers may be caused by the negligence of the owners, accidents, breaches of contract, the forces of nature or other causes. These risks and dangers may arise from foreseeable or unforeseeable causes; and (d) by my participation in these activities and/or use of equipment, I hereby assume all risks and dangers and all responsibility for any losses and/or damages, whether caused in whole or in part by the negligence or conduct of the owners, agents, officers or employees of TCP. This waiver is good through 3/1/2010.                                                  MEDICAL PERMISSION AUTHORIZATION If the participant is of minority age, the undersigned parent or guardian hereby gives permission for TCP to authorize emergency medical treatment as may be deemed necessary for the child named below while participating in PAINTBALL games from this date through 3/1/2010. I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE TCP FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE. ________________________________  ______   ______________   _________________________________ Print Name                                                 Age        Date of Birth            Phone _________________________   _____________________________   _________________________________ Signature                                      Address                                                City, State, Zip ________________________________________    ________________________________________________ Signature of Parent/Guardian                                     E-mail (if less than 18 yrs old) __________________________ Date