ICPC Boys Youth Paintball Day Registration

Saturday, October 24 · Battle Creek Paintball, West Milford, NJ

9:00 AM – Arrive at ICPC Paterson
9:45 AM – Bus departs (sharp!)
11:00 AM – 1.5 hours of paintball

Cost: $30 per youth (includes bus transportation). Register each youth below – use “Add another participant” to register siblings (up to 4).

Open to youth ages 13 and up.

Youth Participant

First name

Last name

Date of birth (must be 13 or older)

Allergies, medical conditions, or anything we should know (optional)

Youth Count

Parent / Guardian

Parent/guardian full name

Phone

Emergency Contact (must be a different person than the parent/guardian above)

Emergency contact name

Emergency contact phone

Emergency contact email

Relationship to youth

Emergency contact check (shows OK when the emergency contact name, phone and email are all different from the parent/guardian)

Waiver & Release

I, the parent/legal guardian of the youth registered above, give permission for my child(ren) to attend the ICPC Youth Paintball Day at Battle Creek Paintball (West Milford, NJ) on Saturday, October 24, including bus transportation to and from ICPC Paterson.

I understand that paintball is a physical activity that involves risk of injury, including bruises, welts and eye injury, and that my child must follow all safety rules and instructions from ICPC staff and Battle Creek Paintball staff at all times, including wearing protective masks on the field.

I voluntarily assume these risks and release the Islamic Center of Passaic County (ICPC), its staff and volunteers from liability for any injury or loss that may occur during this event, except in cases of gross negligence. In case of emergency, I authorize ICPC staff to seek medical treatment for my child if I cannot be reached.

I understand that Battle Creek Paintball may also require its own waiver to be completed before play.

Battle Creek Paintball also requires its own signed waiver. Please download and print the Battle Creek Paintball waiver, have a parent/guardian sign one copy per child, and bring it with you on Saturday, October 24. Youth without a signed waiver will not be able to play. Questions? Call the ICPC office at 973-278-7070.

Agreement

I have read and agree to the waiver and release above.

Parent/guardian signature (type your full name)

Date

Payment Summary

Number of youth registered

Total due ($30 per youth)

Your card will be charged the total above when you submit. Please press Submit only once.

Payment Information

Name on Card

Card Number

Code

Billing Email

Contact Information