PLEASE PRINT THIS FORM AS IT IS REQUIRED FOR ALL ATTENDEES UNDER 17 

PARENTAL CONSENT FORM 

THIS FORM MUST BE SIGNED BY THE LEGAL PARENT OR GUARDIAN 

Name of Participant / Spectator: _________________________________________________ 

Minors may participate at the 4 Next LvL Gamers (hereon 4NLG) tournament with the signed consent of the minor’s parent or legal guardian (“Parent”). If a participant or spectator is under 17 years of age, he/she is considered a minor and must submit this consent form, signed by a parent or legal guardian, upon entry to the Event. Parental Consent Forms will also be available at the onsite Registration. 

Minors Under 12: Participants and spectators under the age of 12 must be accompanied by their parent, legal guardian or a designated adult (18 years of age or older) at all times during the Event. Minors under the age of 12 may not be left under the Supervision of Event staff at any time. 

_______ Parent / Guardian Initial 

Consent to Attendance and Participation: The Event is a video game tournament where an entry fee is charged and cash and other prizes may be awarded to certain winners. Parent further understands that the Event may feature video game competitions featuring video games that have an Entertainment Software Ratings Board (“ESRB”) rating of “M” or Mature, and that this rating indicates that the ESRB, a recognized industry adopted ratings agency, has deemed content of the video games unsuitable for children under 17 years of age. _______ Parent / Guardian Initial 

Assumption of Responsibility: Parent assumes all responsibility and liability for any and all damage and injury suffered by or caused by Minor while at the Event or any areas surrounding the Event. 

Release: By his/her signature, Parent gives his/her permission to allow the above named Minor to attend and participate in any and all Event activities without restriction or limitation, including but not limited to playing video games with an ESRB rating of “M”, and Minor and Parent hereby release and hold harmless 4NLG, its affiliates, subsidiaries, suppliers, related companies, advertising and promotion agencies or partners, and any of their respective officers, directors, employees, representatives and agents, from any and all liability that may arise from Minor’s participation or Parent’s decision to allow Minor to participate in the Event. 

4NLG has Parent’s consent to incorporate any photographs, audio-only or audiovisual recordings in which Minor appears (including, without limitation, news, television and/or motion picture footage) in the Event and/or Advertisements for use as outlined above as well as for historical documentation and/or archival purposes, including without limitation, on 4NLG’s website (e.g., showing Minor’s participation in the Event); and Minor and Parent, on behalf of Minor, hereby waive any right to any additional compensation, including but not limited to, any excerpt and/or reuse fees and/or residual payments. 

Release: Minor and Parent, on behalf of Minor, understand that all of the foregoing is a material inducement for 4NLG to proceed with the Event and Advertisements, and that 4NLG may rely on this Release in proceeding with the Event and Advertisements. Minor and Parent, on behalf of Minor, hereby release the Releases and the advertisers, broadcasters and distributors of the Event, (a) from any and all claims for damage or personal injury arising from or relating to Minor’s participation in the Event, and (b) from all liability and obligation to Minor of any and all nature whatsoever arising out of or in connection with the exercise of the rights granted herein including, without limitation, from any liability for violation of rights of privacy, publicity, defamation, emotional distress or any similar right. 

Parent/Legal Guardian: 

I have read this entire Consent Form and fully understand its contents, terms and conditions. 

I am the Parent / Legal Guardian of ___________________________________________ and give permission for my son / daughter to participate in the 4NLG tournament, including any related events. 

Dated: ____________________ 

Print Name: ________________________________ Signature: ________________________________ 

Home Phone Number:_____________________________ Cell Phone #:__________________________