Fill and Sign the Know All Men by These Presents that for and in Consideration of the Total Sum of One Form

RELEASE AND INDEMNITY AGREEMENT Know all men by these presents, that for and in consideration of the total sum of One Thousand Five Hundred Dollars and 00/100 ($1,500.00), paid to me by and on behalf of the parties hereby released, for the use and benefit of ____________________________, a minor, the receipt and sufficiency of which is hereby confessed and acknowledged, and paid to me in my capacity as the natural mother and next friend of ____________________________, a minor, and pursuant to the authority of that certain decree of the ____________________ Court of ____________________________ County, ____________________________ rendered on the _____ day of _______________________ 20_________; in that certain cause no. _________________ on the general docket of said Court, I, the undersigned ____________________________, as natural mother and next friend of __________________, a minor, have foresaid minor and do by these presents in the capacity as natural mother and next friend of said minor, hereby release and forever discharge ____________________________, ____________________________, ____________________________ and ____________________________, along with their heirs, executors, executrixes, administrators, administratrices, agents, assigns, employees, employers, associated companies, and any and all other persons, associations, partnerships, or corporations associated with or related to the parties hereby released, none of whom admit any liability and all of whom expressly deny liability, from any and all claims, demands, damages, actions, causes of action, of every kind and nature, whatsoever, and particularly on account of any and all claims, known and unknown, which the said minor and the undersigned, or any of them have against the above referred due party as a result of or in any way growing out of that certain accident which occurred on or about __________________, 20_________, wherein said minor received injuries. In order to obtain the compromise settlement hereinabove set out and as a further inducement to the above referred to parties to make the same, I, _________________________, natural mother and next friend of said minor, does hereby individually release and forever discharge said parties from any and all liability to me on account of the injuries and damages sustained by ____________________________, a minor, in the accident hereinabove described, and on account of all damages of every kind and character sustained by me, on account of or in any way growing out of said accident, even though such damages and expenses may be now unanticipated, unexpected or unknown, as well as any and all damages and losses which have already developed. I further warrant that no promises or inducements, not herein expressed have been made to me, and that in executing this Release, I am not relying upon any statement or representation made by any party or parties released, or by their agents or representatives, concerning the nature, extent or duration of the losses or damages sustained by ____________________________, a minor, or myself, or of the legal liability therefore, or concerning any other thing or matter. I further understand that this Release is executed pursuant to a compromise settlement and that its effect is to forever terminate any claims of every kind