SPLMAX.com PARENTAL CONSENT FORM

SPLMAX.com supports the ESRB industry rating system for computer and video games and the voluntary enforcement of this rating system. Any customer who is not at least 13 or 17 years of age is prohibited from playing "T" or (Teen) or "M" Mature rated software respectively. Any participant who will not be at least 18 years of age on the day of the announced event must have parental consent to participate in the SPLMAX.com event. Please print this page, fill out the information and have your parent or legal guardian sign below. You must bring this form with you to the event along with proper identification. If you are under the age of 18 and do not have written parental consent, you may not participate in this tournament/event.

Gamer Tag or Name you will be playing as _____________________________

Participant Name: First _______________ M.I.____ Last_____________________________

Address: __________________________________________________________________

City________________________________________________ State____ Zip___________

Home Phone: (____ )_______ - ____________ Cell Phone: (____ )_______ - ____________

E-mail Address:________________________________________________ Age ________

PARENTAL CONSENT: YOU UNDERSTAND THE "MATURE" RATING OF CERTAIN GAMES AND THAT THEY MAY NOT BE SUITABLE FOR CHILDREN LESS THAN 18 YEARS OF AGE. BY YOUR SIGNATURE, YOU CONSENT TO AND GIVE YOUR PERMISSION FOR YOUR CHILD / LEGAL WARD TO PARTICIPATE IN THE SPLMAX.com EVENT WITHOUT RESTRICTION OR LIMITATION.

You agree to assume all responsibility and liability for any property that is lost, stolen or damaged, and / or for any minor or serious injury, accidental or intentional, to the above named child / legal ward while at the event and / or its surrounding areas. Should your child / legal ward need medical attention, you authorize us to call an ambulance. By my Signature, I grant my permission to allow the above named minor to view (T) and/or (M) rated software and participate in these (T) & (M) Rated Games. You also agree to release SPLMAX.com, its employees, parent company, affiliates and sponsors from any and all liabilities that may arise from your consent to your child/legal ward that is a minor to participate in the SPLMAX.com event.

[ ] Please check the box indicating you have read and understand the rules of the tournament as posted in the RULES section

Parent/Guardian signature __________________________________

Print Name ______________________________________________

Date ___________________________________________________

** If child / legal ward is bringing the signed form with them to the event, they must also bring a valid proof of identification