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REQUIRED FOR ALL GAMERS UNDER 17
XBOX Live Lounge Parental Consent Form
Name of Gamer: ______________________________________ Date of Birth: _________
Minors may participate at G33K’s XBOX Live Lounge 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 Lounge.
Minors Under 7: Participants and spectators under the age of 7 must be accompanied
by their Parent, Legal Guardian or a designated adult(18 years of age or older) at all times
in the G33K XBOX Live Lounge. Minors under the age of 7 may not be left under
the supervision of G33K staff at any time.
______Parent/Guardian Initial
Consent to Attendance and Participation: The G33K XBOX Live Lounge is an online video
game play area where an entree fee is charged for usage(spectating is free). Parent further
understands the G33K XBOX Live Lounge features 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 or caused by Minor while at the G33K XBOX Live Lounge. This
includes banning of an XBOX Live account due to inappropriate behavior.
______Parent/Guardian Initial
Release: By his/her signature, Parent gives his/her permission to allow the above named
Minor to attend and participate in G33K’s XBOX Live Lounge 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 G33K, 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 G33K XBOX Live Lounge.
Rights: In connection with Minor’s participation, the Parent on behalf of the Minor, gives
G33K the right to use recorded footage from the Minor’s game play for advertising and
public interest. Minor and Parent, on behalf of Minor, hereby acknowledge that use of
Minor’s game footage shall not constitute a performance and that Minor shall not be
entitled to any compensation for use of the game footage, nor to any guild or union
payments for use or reuse of such game footage.
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130 Main Street Gloucester, MA 01930 978-865-3259 shopg33k.com
REQUIRED FOR ALL GAMERS UNDER 17
Consent to Clips, Photos, Stills: G33K has Parent’s consent to incorporate any photographs,
audio only or audiovisual recordings in which Minor appears in the G33K XBOX Live Lounge.
Including without limitation, news, television and/or motion picture footage, historical
documentation and/or archival purposes, and G33K’s online website and social networking
platforms.(e.g. showing Minor playing at an XBOX console) 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.
Prohibited Drugs: Parent, on behalf of Minor, represent and warrant that Minor will not take
any illegal drugs, abuse any prescription or over the counter drugs, partake or possess
alcohol, nor take any performance enhancing drugs prohibited by the World Anti-Doping
Agency (WADA). Anyone using illegal drugs will be removed permanently from G33K and
local authorities will be contacted. Anyone who is found to be intoxicated or in the possession
of alcohol will be removed from G33K and local authorities will be contacted.
Release: Minor and Parent, on behalf of Minor, hereby release G33K (a) from any
and all claims for damage or personal injury arising from or relating to Minor’s
participation in the G33K XBOX Live Lounge, 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 of privacy, publicity, defamation, emotional distress or any similar right.
Minor and Parent, on behalf of Minor, hereby indemnify G33K from and against
all claims, actions, losses, damages, judgements and liabilities resulting from any breach
or alleged breach of this agreement and/or any omissions by Minor while participating
in the G33K XBOX Live Lounge. This is the entire agreement and, subsequent to execution,
cannot be modified without writing consent. This agreement shall be exclusively governed by
and construed in accordance of the laws of Massachusetts, United States of America.
G33K Lounge Card: Your G33K Lounge Card is your entry into the G33K XBOX Live Lounge.
It will allow you to enter and reenter the Lounge once a Parent has read and signed the
permission form. Loaning your G33K Lounge Card to a Minor who has not received Parental
consent will result in a ban from the G33K XBOX Live Lounge until you turn 17.
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 G33K XBOX Live Lounge.
Dated: _____________________
Print Name: __________________________________ Signature: __________________________
Street Address:________________________________ City:______________________ State:____
Home Phone Number: _________________________ Cell Phone #: ______________________
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130 Main Street Gloucester, MA 01930 978-865-3259 shopg33k.com