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
