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Individuals Release Inherently Dangerous Activity
Release executed on [Date], by [Name] of [Address], hereinafter referred to as "Releasor".
In 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(s)], releasor, for [Name(s)], (if applicable, add: participant spouse), legal representatives, heirs and assigns, hereby releases, waives and discharges [Name(s)], releasee, its officers and members, (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, add: participant 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 releasors 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).
Releasor 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.
Releasor 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: (enumerate).
Releasor 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 (State) under (insert appropriate law), and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Neither the Releasor and Participant has made any representations nor promises, other than those contained in this release or in some further writing signed by the party making the representation or promise.
In witness whereof, releasor has executed this release at (state place of execution) the day and year first above written.
This Section for Notary:
STATE OF -------)
) ss: [date]
COUNTY OF ------)
On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
[Name of Notary Public]
My commission expires: [date]