Gamerz Arena LLC, hereafter referred to as GzA, is dedicated to protecting your child from any type of harm while they are being entertained. The facility is completely free of drugs, alcohol, tobacco and violence. Your child will only have access to a specific internet game sites, surfing the internet is not available. The facility encourages social interaction, good sportsmanship, friendly competition, and a fun gaming experience. The Entertainment Software Review Board (www.esrb.com) has established a rating system similar to the movie rating system. The games are rated by suggested age groups, and some of the games at our facility are rated (M) Mature (17 and older). We DO NOT carry (A) Adult games. We enforce these standards unless we receive direction otherwise from you, the parent/legal guardian.

Name of Child (print) _____________________________User Name_________________Date of birth_______________

Parental Acceptance of Responsibility/Release of Liability (see Membership Agreement/Release of Liability for details)

(This section required to be completed for anyone under 18 years of age for membership and release of liability)

We do not carry “A” rated games, and we take every reasonable precaution to ensure that your child is not subject to inappropriate material, however, you agree to release GzA, its members, directors, employees, staff and sponsors from liability resulting from willful or inadvertent exposure to such material.

By signing below, I certify that I am the parent/legal guardian of the above named child, I have read, agreed, and signed the Membership Agreement/Release of Liability form, and agree to accept all liability and responsibility for the actions of my child, and accept all liability resulting from my child’s use of equipment owned, operated or sold by GzA, and agree to all terms in the Membership Agreement/Release of Liability form.

Parent/Legal Guardian signature __________________________________________


Parent/Legal Guardian (print) __________________________________Date_______________

Address ____________________________________________________________Phone#_________________________

Parental Authorized Rating Level (Optional)

(Fill out only if you approve your child to be given access to a rating level higher than the ESRB suggests)

By signing below, I certify that I am the parent/legal guardian of the above named child and I grant permission for my child to access content up to and including the highest rating I have indicated below. I understand that this rating is higher than what is normally suggested by the ESRB and I accept full responsibility for my decision. I release GzA, its members, directors, employees, staff and sponsors from any liability resulting from my child’s access to these games or other content within the rating level I have authorized.

______Teen: Initial if your child is younger than 13 and you approve them to be able to play Teen rated games

______ Mature: Initial if your child is younger than 17 and you approve them to be able to play Mature rated games

Parent/Legal Guardian signature __________________________________________

Parent/Legal Guardian (print)__________________________________Date_______________

Address______________________________________________________________Phone#________________________

If you would like to revoke your child from any part or the entire Agreement, please come visit our store.

Parents of minors are welcome to visit our store and observe our policies, practices and exciting gaming experiences.