Form Fm S810 - Release, Waiver, And Indemnity Agreement (Page 2 of 2) in pdf

Form Fm S810 - Release, Waiver, And Indemnity Agreement Page 2

claims or causes of action by (NAME OF MINOR) or by any other person or entity, by whomever or

wherever made or presented, and under no circumstances will the undersigned parent or guardian of

(NAME OF MINOR) present any claim against (NAME OF ORGANIZATION) and said persons

for personal injuries, property damage, wrongful death, or otherwise, caused by any act of

negligence by (NAME OF ORGANIZATION) and said persons.

The undersigned parent or guardian represent that he/she has read this Release, has requested and

has been provided with, or has requested and declined advisement on the potential dangers/risks of

engaging in the observation, activities, or instruction offered, assumes all risks associated with such

dangers and risks, and is fully aware of and understands the terms and the legal consequences of the

signing of this Release. The undersigned parent or legal guardian intends his or her signature to be a

complete and unconditional release of all liability to the greatest extent allowed by law and if any portion

of the Release is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal

force and effect.

DATED:

SIGNATURE OF PARENT OR GUARDIAN FOR (NAME OF MINOR):

THIS RELEASE WAS RESEARCHED AND DRAFTED BY THE LAW FIRM OF:

MCKAY BYRNE & GRAHAM

3250 WILSHIRE BLVD STE 603

LOS ANGELES CA 90010-1578

(213) 386-6900

IT IS MADE AVAILABLE AS A SAMPLE RELEASE/WAIVER WITH THEIR PERMISSION.

NEITHER MCKAY, BRYNE & GRAHAM NOR CHURCH MUTUAL INSURANCE COMPANY

WARRANT THAT IT IS APPROPRIATE FOR USE BY ANY OF OUR INSUREDS. THE

RELEASE/WAIVER WAS DRAFTED AS A SAMPLE DOCUMENT AND MAY NOT BE

APPROPRIATE FOR THE SPECIFIC NEEDS OF A PARTICULAR ORGANIZATION.

THIS RELEASE, WAIVER, AND INDEMNITY AGREEMENT IS NOT A SUBSTITUTE FOR GOOD

PRACTICE, PROPER SUPERVISION, AND REPAIR. THERE IS NO GUARANTEE THAT THIS

RELEASE WILL PROTECT ANY FACILITY THAT CHOOSES TO USE IT. BEFORE USING THIS

SAMPLE DOCUMENT OR ANY DOCUMENT LIKE IT, YOU SHOULD CONSULT WITH YOUR

OWN ATTORNEY TO MAKE CERTAIN THAT THE DOCUMENT YOU EVENTUALLY USE IS

CORRECT AND CURRENT UNDER THE LAW OF YOUR PARTICULAR JURISDICTION AND

THAT THE DOCUMENT MEETS YOUR NEEDS FOR YOUR PARTICULAR SITUATION.

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FM:S810 (4-2004) MBG

Form Fm S810 - Release, Waiver, And Indemnity Agreement Page 2