ARKANSAS LAN Liability Disclaimer and Image Release.

Please read this form completely and sign it using your REAL LEGAL NAME. If you are under 18 years of age, the form must be filled out by a parent or legal guardian. Failure to complete this form fully will result in your being barred from the event.

I ______________________________ understand that by checking these boxes and signing this form, I agree to all terms set forth herein.

[ ] ARKANSAS LAN is a Local Area Network (LAN) party to be held at any location organizers choose and may hereafter be referred to as "the event."

[ ] I release the ARKANSAS LAN organization and all subsidiaries from any and all liability for damage to or loss of my equipment and property and injury to my person that may occur during the time of the event which I spent away from the event (i.e. out getting food, sleeping in a motel, etc. ), regardless of whether this damage and/or injury is accidental or intentional on the part of another person.

[ ] I agree to take full moral, legal, and financial responsibility for any damage to or loss of the equipment and property of others and any injury to the person of others I may cause at the event, whether accidental or the result of intentional action including damage to the property of ARKANSAS LAN organization and all subsidiaries.

[ ] I agree to allow the ARKANSAS LAN organization and all subsidiaries to use images of me at the event for future publicity of similar events.

[ ] I understand that all transportation and other accommodations before, during, and after the event are my responsibility. If I am asked or forced to leave the event early, I will still be responsible for all transportation and accommodations.

[ ] I will not bring illegal substances to the event. I understand that should I bring illegal substances to the event, I will be prosecuted to the fullest extent of the law. I will not bring any weapons to the event. I understand that the definition of a weapon is ultimately up to the event staff and (Ark. Code 5-1-102.)

[ ] I understand that there may be minors at the event. I will not bring alcohol, tobacco, or adult-oriented material to the event with intent to distribute them to minors. I understand that should I provide access to any of these to any underage attendee of the event, I will be prosecuted to the fullest extent allowed by law. (Ark. Code 5-27-205)

[ ] I will not participate in illegal copying of copyrighted material. (U.S. Code Title 17 P.L. 108-482)

[ ] I understand that failing to follow any of these rules and the "House Rules" defined at www.spacitylan.com can result in my immediate removal from the event. I understand that the event's staff can remove me from the event at any time for any reason without a refund.



Emergency Contact Name:___________________________________________ Phone Number:(_________)_______________________


Signature______________________________________________________ Date__________________________


E-Mail____________________________________________ Screen name____________________________

Complete this portion only if you are the parent or legal guardian of an event attendee under the age of 18.

I ___________________________________ understand that by checking these boxes and signing this form, I agree to all terms set forth herein.

[ ] I have read and understand all the above points and agree to them. I have read and discussed all of these terms with my child, and s/he understands and agrees to abide by them.

[ ] I understand that some of the games played at the event both in official tournaments and in the course of free play may involve graphic violence, coarse or objectionable language, and/or adult oriented materials. I have discussed the proper reaction to such images in media with my child, and will not hold ARKANSAS LAN organization or subsidiaries responsible should my child be exposed to such images.

[ ] I understand that should I wish my child removed from the event for any reason, it is my responsibility to do so.

[ ] I understand that should my child be prematurely removed from the event for any reason, I will be contacted immediately by the event staff, and will be responsible for any transportation or other accommodations for my child.


Signature_____________________________________________________________Date__________________________________