For Investigating Unit: Waiver and Release of Liability Assumption of Risk and Indemnity Agreement

— THIS FORM IS TO BE SIGNED BEFORE ALL INVESTIGATIONS —

In consideration of permitting me, _____________________________________________________________________ to allow
(CLIENT’S NAMES)

_____________________________________________ to participate in activities and related operations conducted by ____________ _____________________________________ beginning on the (day)____ of (month) ______________________, (year)______, I, for myself, my personal representatives, heirs and next of kin: HEREBY acknowledge that ______________________________________ __________________________is not responsible for any serious injury and/or death and/or property damage prior to, before, and after investigation. I further acknowledge that what can be found involves certain risks and injuries that can occur which require treatment in a psychiatric and/or medical institution or other facility. I UNDERSTAND that certain sites which are necessary for research may be conducted and the Releasees are exempt from any kind of loss or damage. I HEREBY INDEMNIFY, RELEASE, WAIVE, DISCHARGE AND AGREE NOT TO SUE ________________________________________________________, the above, its facility, the leaders, or any of its officers, instructors, agents, representatives, or employees (the Releasees) from all liability to myself, my personal representatives, assigns, heirs, and next of kin for any and all loss or damage, and any claim or demands therefore on account of injury to my person, property, or resulting in my death, arising out of or related to participation and/or instruction in said course, activities, or any other related operations that may occur, whether caused by the negligence of the Releasees or otherwise. I hereby assume full responsibility for any risk of bodily injury, death, or property damage. I hereby acknowledge that injuries or damages received may be compounded or increased by negligent rescue operations or procedures of the Releasees and agree that this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by Releasees, including negligent operations. I have read this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement fully and understand its terms. I understand I have given up substantial rights by signing it, am aware of its legal consequences, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the greatest extent. I have had the opportunity to personally discuss with the __________________________ ___________________________in engaging in the course and/or activity of _____________________________________________ investigation, research, and related operations.

Client’s Name:_________________________________________________ ____________________________________________________
Date____/_____/______
(PLEASE PRINT FIRST AND LAST NAME) (SIGNATURE REQUIRED)

Client’s Name:_________________________________________________ ____________________________________________________
Date____/_____/______
(PLEASE PRINT FIRST AND LAST NAME) (SIGNATURE REQUIRED)

Witness:________________________________________________________ ____________________________________________________
Date____/_____/______
(PLEASE PRINT FIRST AND LAST NAME) (SIGNATURE REQUIRED)

I intend my signature to be a complete and unconditional release of all liability to the greatest extent and further agree to indemnify, save, and hold harmless the Releasees. Additionally, I understand the risks of investigating and have had the opportunity to personally discuss the activities with __________________________________________________ prior to commencement of these activities.

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