HIGH SCHOOL ESPORTS CHAMPIONSHIPS

ONLY USE THIS APPLICATION IF YOU CAN PHYSICALLY COMPETE IN OUR SCHENECTADY NY LOCATION FOR THIS TOURNAMENT. NO REFUNDS WILL BE AWARDED FOR THIS APPLICATION

Home Address

First Name *

Last Name *

Email Address *

Phone Number *

Street Address

Address Line 2

Country

City *

State *

Age

Zip Code

Player Registration

Game

High School Pass *

NBA 2K20 (November 9 & 10, 2019)

FIFA 20 (November 23 & 24, 2019)

ROCKET LEAGUE (December 14 & 15, 2019)

SMASH ULTIMATE (February 15 & 16, 2020)

MODERN WARFARE (March 14 & 15, 2020)

PUBG (April 18 & 19, 2020)

Total:

$0.00

Game Platform *

+-

Twitch Handle

School Name *

Name of Advisor/Captain/Coach *

Advisor/Captain/Coach Email Address *

Name of Team Mates

+-

Consent *

I ACKNOWLEDGE THAT THIS FORM IS REQUIRED FOR ALL CUSTOMERS 17 YEARS OF AGE OR YOUNGER PRIOR TO PLAYING AT GAMING INSOMNIACS OR ANY OF ITS SUBSIDIARIES.

At Gaming Insomniacs, we support and follow the Entertainment Software Rating Board’s (ESRB) rating system for computer and console games. Under no circumstances are players 17 years of age or younger permitted access to M rated games without parental permission. All players will follow the ESRB rating system when playing at Gaming Insomniacs and only with parental permission and the signing of this form will players be allowed to play games that are not rated for their age group. Parents and or guardian can select the ratings each player can play. Gaming Insomniacs makes every effort to provide technology and professional staffing in order to prevent minors from accessing/viewing inappropriate games.

I have read and understand the rating system of the ESRB and am aware that the above-named minor will be playing games at most rated “M” for Mature at Gaming Insomniacs.

I release and hold Gaming Insomniacs, its staff and owners harmless in the event the above-named minor accesses or views inappropriate games or internet sites, whether by bypassing screening efforts established and provided by Gaming Insomniacs. This includes but not limited to viewing other users, gamers or patrons who are using Gaming Insomniacs equipment. I understand and agree that Gaming Insomniacs staff or authorized agents may collect and maintain certain personal information about my child, including first and last name, birth date, gender, physical address, e-mail address. Photograph and video content associated with marketing efforts of Gaming Insomniacs maybe collected as well. I further understand and agree that such information will only be disclosed to third parties if Gaming Insomniacs has in good faith belief that disclosure is reasonably necessary to comply with the law or to protect the interests of the organization and its partners, or if authorized third parties need the information for the purpose of awarding prizes. I have read the above and give my permission for Gaming Insomniacs to collect, use, and disclose personal information about my child in accordance with the terms stated herein.

Teen (T) and MATURE (M) RATING DISCLAIMER: In some cases, games rated “M” for mature audiences (18 and older) are among the most popular games available. They are given this rating as a conservative precaution because of the action involved. BY CKECKING THIS BOX, YOU UNDERSTAND THAT THE “T/TEEN” OR “M/MATURE” RATING OF CERTAIN GAMES IN THIS EVENT MAY NOT BE SUITABLE FOR CHILDREN LESS THAN 18 YEARS OF AGE. I give consent and permission for the above-named minor to participate in playing video games of an M rating at Gaming Insomniacs and any of its subsidiaries.

Billing Address

Same as Home Address

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Payment

Credit Card Type *

Name on Card *

Credit Card Number *

Expiration Date *