Kids' World Parental Agreement

PARENT'S RELEASE AND INDEMNITY AGREEMENT

In consideration of the payment to the undersigned of the sum of

DOLLARS ($), and for other good and

valuable considerations, the receipt of all of which is hereby acknowledged, the undersigned

parent and guardian of a minor, does forever release, discharge and

covenant to hold harmless, and

, their heirs, administrators, executors, successors and

assigns, from any and all claims, demands, damages, costs, expenses, losses of service, actions

and causes of action, belonging to the said minor or to the undersigned or either of them arising

out of any act or occurrence up to the present time, and, without limiting the generality of the

foregoing, particularly on account of all personal injury, disability, property damage, loss or

damages of any kind sustained or that may be hereafter sustained by the said minor or by the

undersigned or either of them as a consequence of an automobile accident that occurred on or

about the day of

The undersigned does hereby bind him/herself and his/her heirs, administrators executors,

successors and assigns to repay to the said and/or

and to any other person, firm or corporation charged

with responsibility, their heirs, administrators, executors, successors and assigns, any additional

sum of money that any of them may hereafter be compelled to pay on account of the injuries to

said minor because of the car accident, and the undersigned hereby severally waive any and all

rights of exemption, both as to real and personal property, to which the undersigned may be

entitled under the laws of this or of any other state as against such claims for reimbursement or

indemnity.

As further consideration for the sum paid to me, I hereby indemnify and hold harmless

such person and entity released herein from and against all claims, demands, actions, and

expenses relating to any medical and hospitalization expenses incurred in connection with the

accident that is the subject of this release, including, without limitation, all claims for

subrogation asserted by any entity, including governmental entities, which may have paid such

expenses or reimbursed me for payment of such expenses.

To procure the payment of the said sum, the undersigned does declare that no

representations about the nature and extent of any injuries, disabilities or damages made by any

physician, attorney or agent of any party released, nor any representations regarding the nature

and extent of legal liability or financial responsibility of any of the parties released, have induced

her to make this release and indemnity agreement; that in determining the amount of the said

sum there has been taken into consideration not only the ascertained injuries, disabilities and

damages, but also the possibility that the injuries sustained may be permanent and progressive

and recovery therefrom uncertain and indefinite, so that consequences

not now anticipated may result from the said accident.

The undersigned agrees, as a further consideration and inducement for this release and

indemnity agreement, that it shall apply to all unknown and unanticipated injuries and damages

directly and indirectly resulting from the said accident, as well as to those now disclosed.

The undersigned understands that the parties hereby released admit no liability of any

sort by reason of said accident and that said payment in compromise is made to terminate further

controversy, respecting all claims for damages that the undersigned and said minor of the

undersigned have heretofore asserted or might personally or through personal representatives

hereafter assert because of said accident.

Signed and sealed this day of

STATE OF ALABAMA:

COUNTY OF :

I, the undersigned Notary Public in and for said State and County, hereby certify that

whose name is signed to the foregoing Release and who is known to me,

acknowledged before me on this day that, being informed of the contents of the Release, he/she

executed same voluntarily on the day the same bears date.

Given under my hand and notarial seal this day of

NOTARY PUBLIC

My Commission Expires: