PARENT OR GUARDIAN’S PERMISSION TO PARTICIPATE

PARENTAL CONSENT FORM

Permission to Participate

For your child to participate in _____________________________ (“Event”), which includes we require your consent for your child to participate in the Event.

I am the parent or legal guardian of __________________________________ (“Minor”)

who is under 18 years of age. I hereby consent to Minor’s attendance and participation in the Event consisting primarily of PC and console video game tournaments in which an entry fee is charged and cash and other prizes may be awarded to certain winners.

I am aware the Events may feature PC and console video games that may have a rating of “M” for Mature as specified by the Entertainment Software Ratings Board. I am aware this rating indicates the ESRB has deemed the content of the PC or console video game to be unsuitable for children under 17 years old.

I assume all responsibility and liability for any injury, minor or serious, accidental or intentional, to Minor while at the Event. By my signature below as the Parent or Legal Guardian, I give my permission to allow the Minor to attend and participate in this Event and all activities at the Event without restriction or limitation, including, without limitation playing PC and console video games with ESRB ratings of “M” and I release KOTC (NJHALO, NJMADDENBALLERS, KINGOFTHECOUCH) including it’s organizers, sponsors, and affiliates from any and all liabilities that may arise from my decision to allow the Minor to participate in the Event.

Parent or Legal Guardian

_______________________________ __________________

Signature of Parent or Legal Guardian Date

_______________________________

Printed Name of Parent or Legal Guardian

Address of Parent / Legal Guardian: ___________________________________

___________________________________

Telephone # of Legal Guardian: ___________________________________

Emergency Contact & Phone Number: _______________________