Waiver and Release of Liability Form for Switzerland County, Indiana
FOR MYSELF AND MY MINOR CHILD OR CHILDREN, I HEREBY ASSUME ALL OF THE RISKS OF TRANSPORTING SAID CHILD OR CHILDREN IN A VEHICLE PROVIDED BY SWITZERLAND COUNTY, INDIANA OR USING MY OWN VEHICLE TO TRANSPORT SAID CHILD OR CHILDREN WHILE PERFORMING DUTIES FOR SWITZERLAND COUNTY, INDIANA anytime hereafter, and waive, release, and discharge Switzerland County, Indiana and its elected officials, employees, volunteers, agents, representatives, insurers, from any and all liability, including, but not limited to, liability arising from the negligence or fault of the entities or persons being released, for my or my child or children’s death, disability, personal injury, property damage, property theft, or actions of any kind which may occur to me or my child or children as a result of participation in the above described activity. I agree to indemnify, hold harmless, and promise not to sue the entities or persons mentioned above from any and all liabilities or claims made as a result of operation of vehicles as described above, whether caused by the negligence of those released or otherwise.
This accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
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Print Drivers Name Age Driver’s Signature
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Parent Signature (If participant is under 18 years old, parent must sign also)
PARENT/GUARDIAN WAIVER FOR MINORS (Under 18 years old)
The undersigned parent and natural guardian does hereby represent that he or she is, in fact, acting in such capacity, has consented to his or her child, children, or ward being transported as described above in a county-provided vehicle or while I am on county business in a private vehicle and agree individually and as parent or guardian on behalf of the child, children, or ward, to the terms of the Waiver and Release of Liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon those parties because of any defect in or lack of such capacity to so act and release those parties on behalf of the minor or minors and the parents or legal guardian.
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Print Child’s Name Age Date
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Print Child’s Name Age Date
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Signature of Parent or Guardian Age Date
(Res. 02-18-2014, passed - -)