"Release, Idemnification and Hold Harmless Agreement Template - Sample"

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RELEASE, IDEMNIFICATION AND HOLD HARMLESS AGREEMENT
In consideration of participating in ___________________________________ [activity], and for other good and valuable
consideration, I hereby agree to release and discharge from liability arising from negligence _______________________ [name of
insured business] and its owners, directors, officers, employees, agents, volunteers, participants, insurers, and all other persons or
entities acting for them (hereinafter collectively referred to as “Releasees”), on behalf of myself and my children, parents, heirs,
assigns, personal representative and estate, and also agree as follows:
1.
I acknowledge that _________________________ [activity] involves known and unanticipated risks which could result in
physical or emotional injury, paralysis or permanent disability, death and property damage. Risks include, but are not
limited to, _________________________________________________________ [actions that might result in injury];
medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply
cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity.
2.
I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of
the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if
at any time I believe the event conditions are unsafe or that I am unable to participate due to physical or medical
conditions, then I will immediately discontinue participation.
3.
I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims,
demands, or causes of action which are in any way connected with my participation in this activity, or my use of the
equipment or facilities. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone
acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and
hold them harmless for all such fees and costs.
4.
I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this
activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or
physical condition which could interfere with my safety in this activity, or else I am willing to assume – and bear the costs of
– all risks that may be created, directly or indirectly, by any such condition.
5.
In the event that I file a lawsuit, I agree to do so solely in the state where Releasees’ facility is located, and I further agree
that the substantive law of that state shall apply.
6.
I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full
force and effect.
By signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, that I have
waived my right to maintain a lawsuit against the Releasees.
I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing.
Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be
significantly greater if I were to choose not to sign this release, and I agree that the opportunity to participate at the stated cost in
return for the execution of this release is a reasonable bargain. I have read and understood this document and agree to be bound
by its terms.
Signature:_________________________________________ Print Name:____________________________________
Address:_____________________________________ City:____________________ State:_______ Zip:_____________
Telephone (____)______________________ Date:_____________________
PARENT OR GUARDIAN ADDITIONAL AGREEMENT
(Must be completed for participants under the age of 18)
In consideration of__________________________ (PRINT minor’s names) being permitted to participate in this activity, I further
agree to indemnify and hold harmless Releasees from any claims which are brought by or on behalf of minor or are in any way
connected with such participation by minor.
Parent or Guardian________________________________ Print Name________________________ Date__________
RELEASE, IDEMNIFICATION AND HOLD HARMLESS AGREEMENT
In consideration of participating in ___________________________________ [activity], and for other good and valuable
consideration, I hereby agree to release and discharge from liability arising from negligence _______________________ [name of
insured business] and its owners, directors, officers, employees, agents, volunteers, participants, insurers, and all other persons or
entities acting for them (hereinafter collectively referred to as “Releasees”), on behalf of myself and my children, parents, heirs,
assigns, personal representative and estate, and also agree as follows:
1.
I acknowledge that _________________________ [activity] involves known and unanticipated risks which could result in
physical or emotional injury, paralysis or permanent disability, death and property damage. Risks include, but are not
limited to, _________________________________________________________ [actions that might result in injury];
medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply
cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity.
2.
I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of
the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if
at any time I believe the event conditions are unsafe or that I am unable to participate due to physical or medical
conditions, then I will immediately discontinue participation.
3.
I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims,
demands, or causes of action which are in any way connected with my participation in this activity, or my use of the
equipment or facilities. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone
acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and
hold them harmless for all such fees and costs.
4.
I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this
activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or
physical condition which could interfere with my safety in this activity, or else I am willing to assume – and bear the costs of
– all risks that may be created, directly or indirectly, by any such condition.
5.
In the event that I file a lawsuit, I agree to do so solely in the state where Releasees’ facility is located, and I further agree
that the substantive law of that state shall apply.
6.
I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full
force and effect.
By signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, that I have
waived my right to maintain a lawsuit against the Releasees.
I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing.
Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be
significantly greater if I were to choose not to sign this release, and I agree that the opportunity to participate at the stated cost in
return for the execution of this release is a reasonable bargain. I have read and understood this document and agree to be bound
by its terms.
Signature:_________________________________________ Print Name:____________________________________
Address:_____________________________________ City:____________________ State:_______ Zip:_____________
Telephone (____)______________________ Date:_____________________
PARENT OR GUARDIAN ADDITIONAL AGREEMENT
(Must be completed for participants under the age of 18)
In consideration of__________________________ (PRINT minor’s names) being permitted to participate in this activity, I further
agree to indemnify and hold harmless Releasees from any claims which are brought by or on behalf of minor or are in any way
connected with such participation by minor.
Parent or Guardian________________________________ Print Name________________________ Date__________