Release Of Claims Form printable pdf download

STATE OF SOUTH CAROLINA )

)

RELEASE OF CLAIMS

COUNTY OF RICHLAND

)

WHEREAS, the undersigned has requested of the Richland County Sheriff’s Department

permission to ride in a Richland County Sheriff’s Department Vehicle.

WHEREAS, the Richland County Sheriff’s Department does not object to this accommodation

on its part, providing the undersigned assumes the risk involved in this endeavor.

NOW, for and in consideration of allowing the undersigned to ride as a passenger in a Richland

County Sheriff’s Department vehicle, I hereby release the Richland County Sheriff’s Department

and the County of Richland, from all claims, demands and causes of action, that the Releaser

may now have or that might subsequently accrue to Releaser, arising out of or connected with,

directly or indirectly, the accommodation afforded to the Releaser on the part of the Richland

County Sheriff’s Department and the County of Richland in allowing the Releaser to ride as a

passenger in a Richland County Sheriff’s Department vehicle.

The Releaser further agrees that he/she is cognizant that he/she may receive injuries, damages, or

other sickness as a result of riding in said Sheriff’s car but, further, hereby releases the above

mentioned governmental agencies from all liability, claims, demands, costs, charges and expenses

from any future personal injuries, damages and/or sickness that might be sustained by the

Releaser, further shown as the undersigned.

The Releaser, same being the undersigned, understands that these injuries, damages and/or

sickness that are unknown to him/her at the present time further releases any unknown

complications which may arise in the future from the injuries, damages and/or sickness of which

he/she is presently unaware and are all covered by this Release; and, further, that this was

brought to the Releaser’s attention and discussed prior to his/her signing said Release.

The Releaser, same being the undersigned, further releases, not only of himself/herself, but for

his/her heirs, legal representatives and assigns, the Richland County Sheriff’s Department and the

County of Richland from any and all claims and causes of action including, without limitations,

claims of property damage, direct or indirect medical expenses, pain and suffering, disability, loss

of income, if any, based on any injuries, damages and/or sickness that he/she may sustain as a

result of riding in the Sheriff’s vehicle.

As an additional consideration for allowing the Releaser, same being further designated as the

undersigned, to ride the Sheriff’s vehicle, he/she agrees to indemnify the Richland County

Sheriff’s Department, and the County of Richland, their legal representatives and assigns against

any loss from any and all further claims, demands and actions at law or in equity that may

hereafter, at any time, be made or brought by any other person, institution and/or corporation of

agency of a government for damages on account of any future injuries or other damages sustained

in consequence of the above describes accommodation on the part of the Richland County

Sheriff’s Department.

The consideration stated herein is contractual and the Releaser executes and delivers this Release

after being fully informed of its terms, contents and effects.

Release Of Claims Form