Fill and Sign the Injury Involving Form

FULL AND FINAL RELEASE OF ALL CLAIMS FOR AND IN CONSIDERATION of the sum of ( Insert amount payable ) ( Insert numerical amount ), the receipt and sufficiency of which is hereby acknowledged, the undersigned ________________, individually and as natural father, natural guardian and next friend of ________________, a minor, and the undersigned ________________, (collectively the "Undersigned"), for themselves, their heirs, personal representatives and assigns, the Undersigned do hereby release, acquit and forever discharge ________________, and their agents, employees, associated companies, insurers and any and all other persons or entities (the "Parties Released"), of and from any and all claims, demands, actions, causes of action, damages, costs, expenses, and compensation on account of or in any way arising out of any and all known or unknown damages or expenses, and any and all claims of any kind or nature whatsoever, which the Undersigned or any other person or entity may now or hereafter have on account of, arising out of, resulting from, or in any way connected with ________________ which occurred on ________________ which occurred in ________________ County, ________________ and resulted in injuries to ________________. The Undersigned warrant and covenant that they will never institute any suit or action at law or otherwise against the Parties Released as a result of the aforementioned incident and the Undersigned further agree to indemnify and hold harmless the Parties Released from any and all claims, actions, causes of action, legal proceedings and expenses or costs, including attorneys' fees incurred, which might hereafter be instituted, asserted against or incurred by the Parties Released as a result of any claim or cause of action arising as a result of the injuries and/or damages sustained as a result of the accident mentioned above. - 1 - It is understood and agreed that the execution and delivery of this Full and Final Release has been approved and authorized by Order of the ________________ Court of _______________ County, ________________, in Cause No. _______ on the docket of said court dated the _____ day of _____________, 20______. It is understood that this release releases any and all claims of any type or nature whatsoever which the Undersigned or any person may now or hereafter have against the parties released as a result of the matters mentioned above and that this is a full and final settlement, compromise, accord and satisfaction of doubtful and disputed claims and that the payment made in consideration hereof is not to be construed as an admission of liability on the part of the Parties Released. The Undersigned further covenant and warrant that no claim or any part of a claim, arising as a result of this accident has been assigned to any person, firm, corporation or other entity and that no other person, firm corporation or other entity has any right of subrogation whatsoever to this claim. The Undersigned warrant and covenant that they are the sole parties in interest as to any claim arising out of the injuries and/or damages sustained by ________________ in the accident mentioned above, all of which claims are fully and finally settled for the consideration shown. The Undersigned further covenant and warrant that they, nor anyone on their behalf will pursue, execute on, or attempt to collect any judgment against any person, firm or corporation that has or may have a right of contribution or indemnity against the parties released by this document. And since the purpose of this settlement is to end this matter forever, the Undersigned agree, covenant and warrant that, should it develop that there are any errors or mistakes, whether legal or actual and whether mutual or unilateral, which causes this document to be defective or which causes the release and indemnification of the Parties Released to be less than full and - 2 - complete, the Undersigned will execute any and all instruments and do any and all things necessary to effectuate a full, final and complete release and indemnification of the Parties Released and all others having any liability in the premises. The Undersigned have carefully read the above and foregoing release and know its contents. The Undersigned warrant that they are over the age of twenty - one (21) years and have no disability of any type whatsoever which would prevent them from giving a valid and binding release for themselves and the minor and that they have not been induced to execute this document or enter into this agreement by any other statement, representation or warranty made by any party hereby released or anyone acting in their behalf. This release contains the entire agreement between the parties, and with regard to the matters set out, there are no other understandings or agreements between the parties except as is specifically set out. WITNESS THE EXECUTION of this release on this the _______ day of ________________, 20_____. BY: _______________________________________________________ __________________, Natural Friend, Natural Father and Guardian of ________________, a Minor ________________, Individually - 3 -