Fill and Sign the Give Kids the World Parental Agreement Form

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 ___________, _________. __________________________________________(Signature of Parent) 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 PUBLICMy Commission Expires:___________________