Legal Personal Release Form

LEGAL PERSONAL RELEASE FORM

This Personal Release Agreement (the "Agreement") is entered into on this day of , by and between Releasor Name: (the "Releasor"), residing at and Releasee Name: (the "Releasee"), with primary contact address at .

RECITALS

WHEREAS, on or about day of , , an event described as:

WHEREAS, Releasor asserts certain claims, demands, causes of action, or allegations arising out of or related to the event described above; and WHEREAS Releasee denies any liability or wrongdoing but the parties wish to avoid the burden and expense of litigation and to settle and resolve all disputes between them on the terms set forth below.

NOW, THEREFORE, in consideration of the mutual covenants, representations and other good and valuable consideration set forth below, the parties agree as follows:

1. DEFINITIONS

For purposes of this Agreement, the following terms have the meanings set forth below: (a) "Claims" means any and all actions, causes of action, suits, claims, demands, debts, liabilities, obligations, damages, losses, expenses and costs of any nature, whether known or unknown, asserted or unasserted, fixed or contingent; and (b) "Affiliates" of a party means that party's predecessors, successors, officers, directors, agents, employees, attorneys, insurers, servants and assigns.

2. RELEASE AND WAIVER

In consideration of the promises and consideration recited in this Agreement, Releasor, on behalf of Releasor and Releasor's heirs, executors, administrators, agents, assigns and representatives, hereby fully, finally and forever releases, acquits, and discharges Releasee and Releasee's Affiliates from any and all Claims arising out of or related to the incident described above, whether known or unknown, foreseen or unforeseen, suspected or unsuspected, and including claims for negligence, strict liability, breach of contract, tort, statutory violations, emotional distress, and any other theory of recovery.

Releasor acknowledges and expressly waives all rights under any statute or common law that limits the effect of releases of unknown claims, including any statute commonly described as a "releases of unknown claims" statute.

I acknowledge that this release includes claims that I do not know or suspect to exist in my favor at the time of executing this Agreement.

3. CONSIDERATION

In exchange for the release and promises herein, Releasee agrees to provide to Releasor the following consideration, receipt of which Releasor hereby acknowledges as adequate and sufficient:

4. REPRESENTATIONS AND WARRANTIES

Releasor represents and warrants that Releasor has read this Agreement, understands its terms, is signing voluntarily, has the full right and authority to enter into this Agreement, and has not assigned any rights or claims released herein to any third party. Releasor further represents that no promise or inducement has been made except as expressly set forth in this Agreement.

Releasor acknowledges that Releasor has been given the opportunity to consult with independent legal counsel before executing this Agreement and that Releasor enters into this Agreement with full knowledge of its legal effect.

5. INDEMNIFICATION

Releasor agrees to defend, indemnify and hold harmless Releasee and Releasee's Affiliates from and against any claims, liabilities, losses, damages, costs and expenses (including reasonable attorneys' fees) arising out of or relating to any breach of Releasor's representations, warranties or obligations under this Agreement or from any claim that Releasor lacked authority to release the Claims.

6. CONFIDENTIALITY

The parties agree that the terms, amount and existence of this Agreement will be kept confidential and will not be disclosed to any third party except as required by law or as necessary to enforce the terms of this Agreement, provided that any disclosure to a spouse, attorney, tax or financial advisor may be made on a confidential basis.

7. NO ADMISSION

The parties agree that neither this Agreement nor the furnishing of consideration constitutes or shall be construed as an admission of liability by Releasee, and Releasee expressly denies any liability or wrongdoing.

8. NOTICES

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses set forth below by certified mail, personal delivery, or other method that provides signed proof of delivery.

9. GOVERNING LAW; VENUE

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction specified below without regard to its conflict of laws principles. The parties submit to the exclusive jurisdiction of the courts located in the chosen jurisdiction for the resolution of disputes arising under this Agreement.

10. ENTIRE AGREEMENT; SEVERABILITY

This Agreement contains the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written. If any provision of this Agreement is held invalid, illegal or unenforceable, the remainder of this Agreement shall remain valid and enforceable to the fullest extent permitted by law.

11. AMENDMENT; WAIVER; COUNTERPARTS

No amendment or waiver of any provision of this Agreement shall be effective unless in writing and signed by both parties. No failure or delay by any party in exercising any right shall operate as a waiver of that right. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

12. CERTIFICATION AND ACKNOWLEDGMENT

By signing below, Releasor certifies under penalty of perjury that Releasor has read and understands this Agreement, that Releasor is of sound mind and legal capacity, that Releasor is not relying upon any statement, promise or representation other than those contained in this Agreement, and that Releasor knowingly and voluntarily executes this Agreement.

I certify that I have read and understand this Agreement and that I sign it voluntarily.

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