Release for Minor
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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