Parent or Guardian Permission Form (v1.

4)

Permission to Participate

I hereby permit my child __________________________________ ("Minor Participant"), who is under 18 years

of age, to participate in all upcoming video game tournament Events affliliated with Shadow Gaming, Inc.

I hereby consent to Minor Participant’s attendance and participation in the Event(s), consisting primarily of one or
more video game tournaments, one or more of which may have an entry fee charged, and cash and other prizes
may be awarded to certain winners.

I am aware the Event(s) may feature 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 console video game to be unsuitable for children under 17 years old.

I am also aware that my child may be video recorded and clips/ pictures of him or her may be used on our
website, YouTube page, and other related media sources. Subject to the terms of this agreement I hereby
authorize the company to utilize my Minor Participant’s likeness for marketing and promotional purposes whether
in video, recording, or picture form (“Media”). Company agrees to not distort Media in anyway that would
potentially disparage Minor Child in anyway.

I assume all responsibility and liability for any injury, minor or serious, accidental or intentional, to Minor
Participant during the course of the Event. I have reviewed the terms of service for the tournament and I’m
willing to be bound by them. By my signature below as the Parent or Legal Guardian, I give my permission to
allow the Minor Participant to attend and participate in the Event(s) and all activities at the Event(s) without
restriction or limitation, including, without limitation, playing console video games with ESRB ratings of “M” and I
release Shadow Gaming Inc., it’s organizers, sponsors, and affiliates from any and all liabilities that may arise
from my decision to allow the Minor Participant to participate in the Event(s).

Parent or Legal Guardian Authorization

Printed Name of Parent / Legal Guardian: ___________________________________________________________________

Address of Parent / Legal Guardian: _______________________________________________________

_______________________________________________________

Telephone # of Legal Guardian: _______________________________________________________

Emergency Contact & Phone Number: _______________________________________________________

Paypal Account to send Cash Prizes won, if any: _________________________________________

Signature of Parent or Legal Guardian : _______________________________________________________

Date: _______________________________________________________