executed on __________ (date), by ___________________________________ (name),
of _____________________________________________________ (address), here
referred to as releasor.
consideration of being permitted to participate in ____________________________
(insert nature of dangerous activity, such as: racing events or skydiving or as
the case may be) conducted by ___________________
(name), releasor, for ____________ (himself or herself), (if applicable, here
add: __________ (his or her) spouse,)
legal representatives, heirs and assigns, hereby releases, waives and
discharges ____________________________ (name), releasee, its officers and
___________________________________________ (insert here other parties such as:
promoters, sponsors, advertisers, owners and lessees of the premises) and each
of them, their officers and employees, here referred to as releasees, from all
liability to the releasor, (if applicable, here add: ______________________ (his or her) spouse,) legal
representatives, heirs and assigns, for any and all loss or damage, and any
claim or damages resulting therefrom, on account of injury to releasor’s person
or property, even injury resulting in death of the releasor, whether caused by
the negligence of releasees or otherwise while the releasor is
_________________ (competing, working or for any purpose participating in
___________________________________ (name of activity).
agrees to indemnify the releasees and each of them from any loss, liability,
damage or cost they may incur due to the presence of releasor in or upon
(describe area in which activity will occur), whether caused by the negligence
of the releasees or otherwise.
hereby assumes full responsibility for the risk of bodily injury, death or
property damage due to the negligence of releasees or otherwise while in or
upon ________________________________ (describe area in which dangerous
activity will occur) and while competing, officiating in, working or for any
purpose participating in _____________________________________________________
(name of activity).
expressly agrees that this release, waiver, and indemnity agreement is intended
to be as broad and inclusive as permitted by the laws of the State of ________
________________________ (cite appropriate statute,) and that if any portion
thereof is held invalid, it is agreed that the balance shall, notwithstanding,
continue in full legal force and effect.
witness whereof, releasor has executed this release at
(designate place of execution) the day and year first above written.