Form Fm S810 - Release, Waiver, And Indemnity Agreement printable pdf download

Form Fm S810 - Release, Waiver, And Indemnity Agreement

RELEASE, WAIVER, AND INDEMNITY AGREEMENT

IT IS THE INTENTION OF (PARENT OR GUARDIAN OF MINOR) BY THIS AGREEMENT

TO EXEMPT AND RELIEVE (NAME OF ORGANIZATION) AND ITS OFFICERS, AGENTS,

SERVANTS, OR EMPLOYEES FROM LIABILITY FOR PERSONAL INJURY, PROPERTY

DAMAGE, OR WRONGFUL DEATH OF (NAME OF MINOR) CAUSED BY ANY ACT OF

NEGLIGENCE OF (NAME OF ORGANIZATION) AND ITS OFFICERS, AGENTS, SERVANTS,

OR EMPLOYEES.

For and in consideration of permitting (NAME OF MINOR) to observe, or use any facility or equipment

of (NAME OF ORGANIZATION), or engage in and/or receive instruction in any activity or activity

incidental thereto SOME OF WHICH MAY INVOLVE DANGERS AND RISK OF BODILY

INJURY at: (NAME OF ORGANIZATION) in the city of

, County of ____________,

and State of

, beginning on the day of

, the undersigned parent and/or

guardian of (NAME OF MINOR): hereby voluntarily and absolutely releases, discharges, waives, and

relinquishes any and all loss or damages or actions or causes of action for personal injury, property

damage, or wrongful death occurring to (NAME OF MINOR) as a result of (NAME OF MINOR)'s

observing or using facilities or equipment of (NAME OF ORGANIZATION), or engaging in or

receiving instructions in any activities SOME OF WHICH MAY INVOLVE DANGERS AND

RISK OF BODILY INJURY or in activities incidental thereto wherever or however the same may

occur, and for whatever period said activities or instructions may continue.

The undersigned parent or guardian of (NAME OF MINOR) 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 ORGANIZATION) or its officers, agents,

servants, or employees, the undersigned parent or guardian will indemnify and hold harmless

(NAME OF ORGANIZATION) and its officers, agents, servants, or employees from any and all

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FM:S810 (4-2004) MBG

Form Fm S810 - Release, Waiver, And Indemnity Agreement