In consideration for being a passenger in (Vehicles Description Make, Model and Year), That is driven by (Your Name), I hereby RELEASE, WAIVE, DISCHARGE AND WILL NOT SUE (Your Name or Insurance Company), in the State of ________.
To the best of my knowledge, I fully understand being a passenger in this vehicle. I am fully aware of risks and hazards associated with this. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or any loss or damage to personal property owned by me, as a result of being a passenger in this vehicle, WHETHER CAUSED BY THE NEGLIGENCE OR ACCIDENT or otherwise.
I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES from any loss, liability, damage or costs, including court costs and attorney’s fees, that may incur due WHILE BEING A PASSENGER IN SAID VEHICLE, WHETHER CAUSED BY NEGLIGENCE OR ACCIDENT or otherwise.
It is my express intent that this Release and Hold Harmless Agreement shall bind the members of my family and spouse (if any), if I am alive, and my heirs, assigns and personal representative, if I am not alive, shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of ____________.
I UNDERSTAND THAT THE OWNER OR OWNERS INSURANCE WILL NOT BE RESPONSIBLE FOR ANY MEDICAL COSTS ASSOCIATED WITH AN INJURY I MAY SUSTAIN WHILE BEING A PASSENGER IN SAID VEHICLE.
I also understand that I should and am urged by (Your name) to obtain adequate health and accident insurance to cover any personal injury to myself, which may be sustained during being a passenger in SAID VEHICLE or the transportation to and from SAID JOB.
IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate and complete consideration fully intending to be bound by same.
IN WITNESS WHEREOF, I have hereunto set my hand on this ________ day of ________________, 2015.
__________________
Passenger
__________________
Date
選擇“Disable on www.wenxuecity.com”
選擇“don't run on pages on this domain”
