11. For valuable consideration, the receipt and sufficiency of which hereby are acknowledged, the undersigned _________________________________ (“Releasor”) does hereby, for Releasor and Releasor’s heirs, executors, administrators, and personal representatives, release and forever discharge _________________________________ (“Releasee”) and Releasee’s agents, servants, successors, heirs, executors, administrators, and personal representatives, from all actions, any and all manner of claims, demands, causes of action or suits, including but not limited to claims and suits for bodily injuries that Releasor had, might now have or that might subsequently accrue to Releasor by reason of, or in any way directly or indirectly, connected with, or arising out of the accident occurring on or about ___________________________ (date of accident) at ______________________________________________________________________
_____________________________________________________ (location of accident).
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