IT IS UNDERSTOOD AND AGREED THAT the undersigned, the parents/guardians of ___, in consideration for the payment of ____, the receipt and sufficiency of which is acknowledged, do for ourselves, our heirs,executors, administrators, successors, and assigns, and all other persons, firms, employers, corporations, associations, and
partnerships release, discharge and covenant to hold harmless _____[Services, LLC / Company], its successors, assigns from all obligations, suits, claims, demands of any kind or nature whatsoever, damages, loss of income, expenses, hospital and medical expenses which the undersigned may now have or which may accrue on account of or in any way arising out of all known and unknown personal injuries which have resulted from or may in the future develop from an accident that occurred on or about 07/2016 at or near______.
The undersigned promises to satisfy any and all medical bills and/or liens including but not limited to any and all governmental liens, Medicare liens, Medicaid liens and all other liens, bills, costs and expenses arising from or in any way related to the accident referenced herein, or to insurance coverage or related discussions and negotiations, or to any injuries allegedly arising from the accident. The undersigned agrees to indemnify and hold harmless the released parties and their insurers or representatives from any such liens or claims which may be asserted at any time by any such person or entity. This expressly includes all governmental liens including Medicare and Medicaid liens or any other governmental entity, asserts any further claim related to the accident referenced herein after the signing of this release, I, or my estate or representatives, are fully responsible to pay any such additional claim from the proceeds of this settlement.
The undersigned agrees to indemnify and hold harmless the released parties and their insurers or representatives from any such liens or claims which may be asserted at any time by any such person or entity. In consideration of the above payment, the undersigned agrees to indemnify the released parties and their insurers or representatives and save them harmless from all further liability arising because of any injuries and damages sustained by the undersigned, and, if necessary, in order to save them so harmless, to satisfy on their behalf any judgment against them arising in any way out of the accident.
It is understood and agreed that this settlement is in full compromise of a disputed claim as to both questions of liability and the nature and extent of the injuries and damages, and that neither this release nor the payment made shall be construed as an admission of liability. The undersigned declares that no representation by the party or parties released, or their representatives, regarding their legal liability or financial responsibility, or about the nature and extent of the injuries, disabilities, or damages has induced the undersigned to make this agreement; that in determining the amount of the payment indicated above, the undersigned has considered not only the known injuries, disabilities, and damages, but also the possibility that there may be unknown injuries, disabilities, and damages, and that injuries sustained may be permanent and progressive and recovery uncertain and indefinite, so that unforeseen consequences may occur. The undersigned further declares and represents that no promise, inducement, or agreement not herein expressed has been made to the undersigned; this release contains the entire agreement between the parties hereto; and the terms of this release are contractual and not a mere recital. I have read this release and understand it.
