Fill and Sign the Procedure for Reporting a Dog Bite in Raleigh Nc Form

-1- ABSOLUTE RELEASE FOR AND IN CONSIDERATION of the total sum of ___________________________ and no/100 Dollars ($___________), cash in hand paid, the receipt and sufficiency of which is hereby acknowledged, the undersigned, ___________________________________________, does hereby remise, release and forever discharge ____________________________________, their insurers, heirs, estates, successors, representatives, and assigns of and from any and all actions, causes of action, claims, demands, losses, injuries, expenses and damages of every type, kind and character whatsoever which have heretofore been sustained or which may hereafter be sustained as a result of the injury to ______________________________________ inflicted by a dog owned by _________________________________________________, such injury occurring on the _______ day of _____________________, __________.This consideration is hereby acknowledged by the undersigned to be paid to and received by us in full and complete compromise, settlement, accord and satisfaction therefor.In executing and delivering this release, the undersigned rely wholly upon their own judgment, knowledge and belief as to the nature, extent and duration of the damage which they may have suffered or sustained, or may sustain in the future, as a result of the transaction, occurrence or event. As to the questions of liability involved, the undersigned have exercised their right to legal counsel.It is understood and agreed that this release is executed and delivered, and the sum of money hereinabove specified is paid, as the compromise and settlement of a doubtful and disputed claim. The payment of this money is not to be construed as an admission of liability on the part of the Released parties, but on the other hand, the Released parties specifically deny any such liability therefor.The undersigned further certify that they have fully read and completely understood the same or have had it explained to them. The undersigned parents, _______________and ________________father and mother respectively, of ___________________in consideration of the foregoing settlement and payment, do hereby join in this release instrument and all of its covenants, releasing each and every right and claim which we, as parents, individually and otherwise, have or may ever have on account of or as a result of the accident afore said and any and all injuries suffered by the said child as a consequence thereof, and any and all parental claims for loss of services, medical, -2- hospital, and other expenses incurred or to be incurred; and any and all derivative rights and claims that we may have as parents; and any and all rights and claims provided by law or equity to parents for the injury of their child or otherwise. This release shall be construed according to, and the rights and liabilities of the persons or entities named herein shall be governed by the laws of _______________. WITNESS MY SIGNATURE, this the ____ day of ______________, 20___. _________________________________ WITNESS MY SIGNATURE, this the ____ day of ____________, 20____. _________________________________ WITNESS MY SIGNATURE, this the ____ day of ____________, 20____. _________________________________ APPROVED AS TO FORM:_________________________________ ATTORNEY FOR DATED:__________________________