ABSOLUTE RELEASE WITH COVENANTS
KNOW ALL PERSONS BY THESE PRESENTS that we, the undersigned parties, for and in consideration of the total sum of ____________________ Dollars ($ ____________), cash in hand paid to, ______________________ and ________________________, parents and guardians and next friends of _________________________, a minor, the receipt and sufficiency of which is hereby acknowledged said sums being paid in consideration of this release and these covenants, we, ____________________________ and ___________________________, as natural parents and guardians ____________________________ of a minor do hereby remise, release and forever discharge __________________ and __________________, their insurers, heirs, estates, successors, representatives, assigns, employers, employees, principals, associates, and all other persons, firms, organizations and/or corporations who are in privity therewith whatsoever having any interest or liability in the premises, they being hereinafter designated as the “Releasees”, either directly or indirectly, of and from 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 the injury suffered by _______________, on or about _______________, when ____________, was _____________________________________ (description of injury).
We further release _______________________ and the above named Releasees for all claims, damages or injuries whatsoever arising out of the injuries to ____________________ a minor, we may now have, may have had heretofore, or may have hereafter under the terms of any law or jurisdiction whatsoever on the account of or arising out of the injuries to _______________, a minor.
In executing and delivering this release, we rely wholly upon our own judgment, knowledge and belief about the nature, extent and duration of the damage which 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, we have exercised our right to legal counsel. We further represent and warrant that we have not been influenced by any representations, statements, or warranties made by any person, firm, association, partnership or corporation hereby released, or by any agent or other person representing them concerning the nature, extent or duration of the damages or losses, or the legal liability therefor.
We understand and agree that we are executing and delivering this release, and that the sum of money hereinabove specified is being paid as a compromise and settlement of a doubtful and disputed claim. This consideration is hereby acknowledged by us to be paid to and received by us in full and complete compromise, settlement, accord and satisfaction therefor. We understand that those released hereby deny all liability in the premises and maintain that they were not negligent and that they were not and are not liable to anyone for anything.
We represent, covenant, warrant and guarantee that __________________ is the father, and that ________________________ is the mother, of ______________________, a minor; that and are each over the age of twenty-one (21) years; and that the minor, was _____ (__) years of age at the time of his injury. We certify we are completely competent or authorized to execute this release and that we have fully read and completely understood the same or have had it explained to us.
We, __________________ and _______________________, represent and covenant that we are the sole owners and sole parties in interest in and to all claims, causes of action and demands of any sort under ___________ law and arising out of such accident mentioned above. We agree to indemnify, defend and hold harmless the payer _____________________, ______________________, the releasees named above, and all other persons, firms and/or corporations in privity with them or any of them, against any other claims brought by any person or entity concerning the injuries suffered by ________________, a minor. Said obligation of indemnity includes all claims which may be asserted by, for or on behalf of the estate of ________________, a minor.
In further consideration of such payment, we covenant and agree to forever refrain and desist from instituting, prosecuting or asserting against the Releasees, and all other persons, firms, organizations and/or corporations having any liability in the premises, any claim, demand, action or suit of whatever kind or nature, either directly or indirectly, for injuries or damages of any kind, resulting or to result in any manner from said accident and injuries t0 _______________________ including all expenses necessarily incurred and resulting therefrom, past, present and future.
We further covenant that all medical, hospital, doctor, drug and other bills incurred because of the accident and injuries to have been paid in full, or will be paid immediately hereafter by us; and we covenant and warrant that there have been no assignments or subrogation of any claim or right in the premises to anyone not joining in this release, and the covenants, warranties and guaranties contained herein apply to all persons, individually and in their representative capacity, and in every regard whatsoever; and we agree that, hereafter, the released parties are and shall be forever free of liability and that they, each and collectively, shall be as free of liability in the premises as if the aforesaid accident had never occurred and ______________________ had never been injured.
We, ______________________ and _________________________ father and mother respectively of ______________________ in consideration of the foregoing settlement and payment, join in this release instrument and all of its covenants, releasing every right and claim which we, as parents, individually and otherwise, have or may ever have because of or as a result of the accident aforesaid and all injuries suffered by the said child as a consequence thereof, and any and all parental claims for loss of services, medical, 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 contains the entire agreement between the parties hereto and the terms of the release are contractual and not a mere recital.
Should any mistakes develop in this instrument which cause the release of the releasees to be defective or less than complete, we will execute all instruments and do all things necessary to carry out a full, final and complete release.
The laws of _______________ govern this release and the rights and liabilities of the persons or entities named herein shall be construed accordingly.
WITNESS MY SIGNATURE, this the ____ day of ______________, 20___ .
WITNESS MY SIGNATURE, this the _____ day of ______________, 20__ .
APPROVED AS TO FORM:
ATTORNEY FOR _________________ and
STATE OF _________________________
COUNTY OF _______________________
PERSONALLY APPEARED before me, the undersigned authority in and for the jurisdiction aforesaid, the within named _______________________ who acknowledged that he signed and delivered the foregoing instrument on the day and year therein mentioned and for the purposes therein set forth.
GIVEN under my hand and official seal, this the ___ day of ____________,
My Commission Expires:
STATE OF ___________________________
COUNTY OF _________________________
PERSONALLY APPEARED before me, the undersigned authority in and for the jurisdiction aforesaid, the within named ________________________, who acknowledged that she signed and delivered the foregoing instrument on the day and year therein mentioned and for the purposes therein set forth.
GIVEN under my hand and official seal, this the ____ day of ____________,
My Commission Expires:
State Specific Release Forms
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