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: _______________________