Minor's Compromise Agreement

MINOR'S COMPROMISE AGREEMENT

This Minor's Compromise Agreement ("Agreement") is made effective as of by and between in his/her capacity as parent and natural guardian of (Minor), born ; and (Settling Party). The Guardian and Settling Party are sometimes referred to herein collectively as the "Parties" and individually as a "Party."

RECITALS

WHEREAS, the Minor allegedly sustained injuries and damages arising out of the incident described as: (the "Incident"), which occurred at or about ;

WHEREAS, the Guardian, on behalf of the Minor, has asserted claims against the Settling Party arising from the Incident, including claims for personal injury, medical expenses, pain and suffering, and related damages (collectively, the "Claims");

WHEREAS, the Parties desire to fully and finally compromise, settle, and discharge the Claims on the terms set forth in this Agreement, without further litigation, and subject to any required court approval.

NOW, THEREFORE

In consideration of the mutual covenants and promises contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the Parties agree as follows:

1. SETTLEMENT PAYMENT

1.1 Settlement Amount. In full and final settlement of the Claims, Settling Party agrees to pay the total sum of $ (the "Settlement Amount").

1.2 Payment Terms. The Settlement Amount shall be paid as follows: . Payment shall be made payable to and delivered to the address for Notices set forth in Section 9.

2. RELEASE AND DISCHARGE

2.1 Full Release. Upon receipt and clearance of the Settlement Amount in accordance with Section 1, the Guardian, on behalf of the Minor, hereby irrevocably and unconditionally releases, remises, and forever discharges Settling Party and its past, present and future officers, directors, employees, agents, insurers, attorneys, successors and assigns (collectively, the "Released Parties") from any and all claims, demands, causes of action, liabilities, costs and expenses, known or unknown, suspected or unsuspected, arising out of or related to the Incident or the Claims, whether based on tort, contract, statute or any other legal theory, through the date of this Agreement.

2.2 Scope. The release in Section 2.1 includes, without limitation, all claims for medical expenses, future medical care, pain and suffering, emotional distress, loss of earnings, and other economic and non-economic damages.

3. COVENANT NOT TO SUE; NO FURTHER ACTION

3.1 Covenant Not to Sue. The Guardian agrees, on behalf of the Minor, not to institute, prosecute or permit to be prosecuted any action, claim or proceeding against any Released Party arising out of or relating to the Incident or the Claims that are the subject of this Agreement.

4. ALLOCATION OF FUNDS; LIENS

4.1 Attorney's Fees and Costs. The Parties acknowledge that the attorney for the Guardian is entitled to fees and costs in the amount of $ or of the Settlement Amount. Such fees and costs shall be paid from the Settlement Amount prior to distribution to the Minor.

4.2 Medical Liens. The Guardian warrants that any known medical, hospital or lienholder claims have been disclosed. Known lienholders and amounts:

4.3 Net to Minor. After payment of attorney's fees, costs, and satisfaction of valid liens as provided in this Agreement, the remaining sum shall be held for the Minor. The Guardian agrees to apply such funds for the minor's benefit, subject to any court orders concerning the minor's funds.

5. REPRESENTATIONS AND WARRANTIES

5.1 Authority. The Guardian represents and warrants that he/she is the lawful parent and/or legal guardian of the Minor and has full legal authority to enter into this Agreement on behalf of the Minor, subject to any required court approval.

5.2 No Prior Assignment. The Guardian represents that no assignment or transfer of the Claims has been made to any person or entity that would impair the release or distribution of proceeds provided herein.

6. COURT APPROVAL

6.1 Subject to Approval. The effectiveness of certain provisions of this Agreement and the disbursement of funds for the benefit of the Minor may be conditioned upon approval by a court of competent jurisdiction. The Guardian agrees to seek such approval and to cooperate in obtaining any required orders.

Court Name: Case Number:

7. NO ADMISSION OF LIABILITY

The Parties acknowledge and agree that this Agreement is a compromise of disputed claims and that the payment of the Settlement Amount is not and shall not be construed as an admission of liability, fault, or wrongdoing by any Released Party.

8. TAX MATTERS

Each Party shall be responsible for reporting and paying any taxes that may be imposed as a result of the payments made pursuant to this Agreement. The Parties agree not to characterize any portion of the Settlement Amount for tax reporting purposes without mutual written consent.

9. NOTICES

Guardian/Minor Notice Address

Settling Party Notice Address

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses set forth above, or to such other address as a Party may designate in writing.

10. INDEMNIFICATION

The Guardian shall indemnify, defend and hold harmless the Released Parties from any and all claims, demands, costs or expenses (including reasonable attorneys' fees) arising from any breach of the Guardian's representations, warranties or obligations under this Agreement, including any misrepresentation regarding liens or assignments.

11. MISCELLANEOUS

11.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the state specified by the Parties below, without regard to conflict of laws principles. State:

11.2 Entire Agreement. This Agreement contains the entire understanding and agreement of the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written.

11.3 Severability. If any provision of this Agreement is determined to be invalid, illegal or unenforceable in any respect, such provision shall be severed and the remaining provisions shall continue in full force and effect.

11.4 Amendments; Waiver. This Agreement may be amended only by a written instrument signed by all Parties. No waiver of any provision shall be effective unless in writing and signed by the Party waiving compliance.

11.5 Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument. Facsimile or electronic signatures shall be binding as originals.

11.6 Authority to Execute. Each person executing this Agreement represents and warrants that he or she has full power and authority to execute and deliver this Agreement and to perform the obligations herein.

ATTORNEYS AND ADDITIONAL INFORMATION

Attorney for Guardian/Minor

Attorney for Settling Party

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