Babysitting Form

WAIVER AND RELEASE BY PARENT OF MINOR FROM LIABILITY FOR BABYSITTING

I, , on behalf of (hereinafter referred to as “MINOR”) HEREBY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I or MINOR ever had or may have, arising from or in any way related to MINOR’S baby-sitting on the premises of land owned by in the County of , in the state of at the following address provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.

As according to the Agreement, MINOR understands that the rate of pay shall be $ .00 per hour and that there are certain duties that MINOR will be expected to perform involving the care of while the released party is away. I on behalf of MINOR, consent to the terms of the Agreement indicating MINOR’S duties and responsibilities as a baby-sitter. MINOR understands that the activities associated with baby-sitting could involve dangerous risks and could cause serious or grievous injuries, including bodily injury, damage to personal property and/or death should anything unexpected occur during the usual course of baby-sitting. That injuries can also occur because of the condition of the property (both inside and out) and that the land may pose such dangerous conditions due to insects, pets, etc.; that there are always risks involved when operating utilities such as a stove, oven, washing machine etc. or other natural or man-made hazards. On behalf of myself, MINOR, my heirs, assigns and next of kin, I and said MINOR waive all claims for damages, injuries and death sustained to me, or my property that I or said MINOR may have against the aforementioned released party to such activity whether caused by the ordinary negligence of the released party or otherwise, with the exception of acts of gross negligence, or intentional, willful or wanton misconduct as indicated above.

By this Waiver, I, on behalf of said MINOR, assume any risk, and take full responsibility and waive any claims of personal injury, death or damage to personal property and real property owned by including any activities involving the upkeep and maintenance of the property and any activities conducted throughout the course of MINOR’S stay.

This WAIVER AND RELEASE contains the entire agreement between the parties, and supercedes any prior written or oral agreements between them concerning the subject matter of this WAIVER AND RELEASE. The provisions of this WAIVER AND RELEASE may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties.

The provision of this WAIVER AND RELEASE will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of, , whether by agreement, by operation of law, or otherwise.

I have read, understand and fully agree to the terms of this WAIVER AND RELEASE. I understand and confirm that by signing this WAIVER AND RELEASE said MINOR and I have given up considerable future legal rights. I have signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law.

Medical Conditions. MINOR is subject to the following allergies or medical conditions, and I authorize the released party to disclose these conditions to a physician or other medical professional in the event said MINOR should require emergency medical care:

Prohibited Activities. As a result of the above-mentioned medical conditions, I, on behalf of said MINOR, am prohibiting involvements in the following specific activities:

Date

Printed Name of MINOR

Printed Name of Parent (Guardian)