According to ESRB, this game contains: Animated Blood and Gore, Animated Violence
There's enough violent content in here to make watchful parents uneasy, but the blood can be turned off (well...turned into flowers if the blood color is set to "hippie").
Serious Sam is best appreciated by veteran gamers who have experience with first-person shooters like Doom and Duke Nukem.
Xbox owners have better FPS offerings around, including Halo, Timesplitters 2, and Unreal Championship. Serious Sam also contains a lot of subtle pop-culture references, some of them very funny, that any fan of movies and games will appreciate.
Deaf and Hard of Hearing gamers may miss much of the charm that makes the characters appealing, but the game will be fundamentally playable.