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- RELEASE FOR MINOR
- For and in consideration of permitting [name of student]
- to enroll in and participate in [description of activity]
- in the City of , County of , and State
- of , beginning on the day of , 19 ,
- the Undersigned hereby voluntarily releases, discharges,
- waives and relinquishes any and all actions or causes of
- action for personal injury, property damage or wrongful
- death occurring to him/herself arising as a result of
- engaging in [or receiving instructions in] said activity
- or activities incidental hereto, wherever or however the
- same may occur and for whatever period said activities, or
- instructions may continue, and the Undersigned does for
- him/herself, his/her heirs, executors, administrators and
- assigns hereby release, waive, discharge and relinquish any
- action or causes of action, aforesaid, which may hereafter
- arise for him/herself and for his/her estate, and agrees
- that under no circumstances will he/she or his/her heirs,
- executors, administrators and assigns prosecute or in any
- way whatsoever, present any claim for personal injury,
- property damage or wrongful death against [name of firm],
- or any of its officers, agents, servants or employees for
- any of said causes of action, whether the same shall arise
- by negligence of any of said persons, or otherwise. IT IS
- THE INTENTION OF [individual] BY THIS INSTRUMENT, TO EXEMPT
- AND RELIEVE [name of firm] FROM LIABILITY FOR PERSONAL
- INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY
- NEGLIGENCE.
-
- The Undersigned, for him/herself, his/her heirs, executors,
- administrators or assigns agrees that in the event any claim
- for personal injury, property damage or wrongful death shall
- be prosecuted against [name of firm] , he/she shall
- indemnify and save harmless the same [name of firm] from
- any and all claims or causes of action by whomever or
- wherever made or presented for personal injuries, property
- damage or wrongful death.
-
- The Undersigned acknowledges that he/she has read the
- foregoing two paragraphs, has been fully and completely
- advised of the potential dangers incidental to engaging in
- ____________________, and is fully aware of the legal
- consequences of signing the within instrument.
-
- WITNESS:________________ ______________________________
- Signature
- DATED: _________________ _______________________________
- Signature of Parent or Guardian
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