Fill and Sign the Covenant Not Sue Form

Covenant not to Sue by Parents Regarding Claim of Minor Child In consideration of $ __________________ , receipt of which is acknowledged, we, __________________ (Name of Father) and __________________ (Name of Mother) , of _____________________________________________ (street address, city, county, state, zip code) , covenant to __________________ (Name of Covenantee) , of _____________________________________________ (street address, city, county, state, zip code) , that we will never, individually or as legal guardians, pursuant to court order entered on __________________ (date) in the matter of __________________ (Title of Action), __________________ (docket number) , of __________________ (Name of Child) , our minor __________________ (son/daughter) , institute any action at law or in equity against __________________ (Name of Covenantee) on account of any injury or other loss or damage sustained or that might be sustained by us or by __________________ (Name of Child) as a consequence of the incident occurring on __________________ (date) , at _____________________________________________ (place of incident) , in which _____________________________________________ (description of incident giving rise to claim) . We further covenant that we will not assert against __________________ (Name of Covenantee) any claim or demand that we now have or may have in the future based on the above-described incident. This covenant may be pleaded by __________________ (Name of Covenantee) as a complete defense to any action or proceeding that may be brought or instituted by us or by our heirs or legal representatives in breach of this covenant. We reserve the right to proceed against any and all parties other than ____________ (Name of Covenantee) for the recovery of full satisfaction of any claim for damage that we have or may have arising out of the above-described incident. We execute this instrument and accept the above-stated sum solely as consideration for this Covenant not to Sue __________________ (Name of Covenantee) , the only party intended to be benefited by this covenant. We understand that acceptance of this covenant and payment of such sum by ________________________ (Name of Covenantee) does not constitute an admission of any liability on _______ (his/her) part, and that all liability is denied by _______ (him/her) . This covenant shall bind us and our heirs and legal representatives. It shall inure to the benefit of __________________ (Name of Covenantee) and _______ (his/her) heirs and legal representatives. WITNESS our signatures as of the day and date first above stated. ______________________________ (Signature of Father) _____________________________ (Printed Name of Father) ______________________________ (Signature of Mother) _____________________________ (Printed Name of Mother) Approved as to form and content: _____________________________ Judge of (Name of Court)