Change Version: USA \| Change Version: Canada
US Territories Waiver/Release

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PDF Waiver/Release Form

A Waiver or Release Agreement is used when one party voluntarily surrenders a right or privilage, in exchange for money or other compensation. This agreement can apply to several situations, such as waiving the right to sue in the event of personal injury, accidents, or property damage. It can also apply to satisfaction of debts, or cases in which both parties have been involved in a dispute and wish to release any claims against each other.

More about Waiver/Release legal forms.

Proceed through this form, providing as much information as possible.
Do not use the '&' (ampersand) and '"' (double-quotation mark) characters.
When you are done, click on 'Build Document' at the bottom.

Governing Jurisdiction:

This agreement will be governed by the laws of which nation?

Select a province or territory:

State:

Purpose of Waiver/Release:

What will this waiver or release be used for?

Participant's Contact Information:

First Releasor's Contact Information:

Releasor's Contact Information:

Full Name:

Address:

City:

Select a Nation:

Select a province or territory:

State:

Releasee's Contact Information:

Second Releasor's Contact Information:

Releasee's Contact Information:

Full Name:

Address:

City:

Select a Nation:

Select a province or territory:

State:

Nature of Dispute:

Please enter a detailed description of the dispute:

Nature of Activity:

Please enter a detailed description of the activity:

Date of Activity:

Day (e.g. 5):

Month (e.g. July):

Year (e.g. 2007):

Nature of Activity:

Please enter a detailed description of the activity:

Date of Activity (e.g. 5):

Day:

Month (e.g. July):

Year (e.g. 2007):

Nature of Activity:

Please enter a detailed description of the activity:

Date of Activity (e.g. 7):

Day:

Month (e.g. May):

Year (e.g. 2007):

Nature of Damage:

What was damaged (e.g. mountain bike)?

What caused the damage?

Date of Damage:

Day (e.g. 16):

Month (e.g. February):

Year (e.g. 2006):

Debt Information:

Enter the amount of outstanding debt (e.g. 1,500.00):

Select the currency:

Enter the amount of the original debt (e.g. 10,000.00):

Select the currency:

How did the debt arise?

Date of the Original Debt:

Day (e.g. 3):

Month (e.g. June):

Year (e.g. 2002):

Debt Information:

Enter the amount of outstanding debt (e.g. 3,000.00):

Select the currency:

Enter the amount of the original debt (e.g. 19,000.00):

Select the currency:

How did the debt arise?

Date of the Original Debt:

Day (e.g. 11):

Month (e.g. December):

Year (e.g. 2005):

Dispute Information:

Please provide a detailed description of the dispute:

Date of Accident:

Day (e.g. 9):

Month (e.g. January):

Year (e.g. 2006):

Accident Location:

Where did the accident occur (e.g. 123 Elm St

Name of insurance company:

Date of Accident:

Day (e.g. 12):

Month (e.g. May):

Year (e.g. 2006):

Nature of Accident:

Please provide a detailed description of the accident:

Accident Location:

Where did the accident occur (e.g. 123 Elm St

Name of insurance company:

Nature of Injury:

What caused the injury?

Date of Injury:

Day (e.g 11):

Month (e.g. March):

Year (e.g 2005):

The injury occurred at what location/place (e.g. Elmbrook School

Nature of Injury:

What caused the injury?

Date of Injury:

Day (e.g. 4):

Month (e.g. April):

Year (e.g. 2003):

The injury occurred at what location/place (e.g. Elmbrook School

Nature of Injury:

What caused the injury?

Date of Injury:

Day (e.g. 5):

Month (e.g. June):

Year (e.g. 2006):

The injury occurred at what location/place (e.g. Elmbrook School

Nature of Injury:

What caused the injury?

Date of Injury:

Day (e.g. 14):

Month (e.g. July):

Year (e.g. 2006):

The injury occurred at what location/place (e.g. Elmbrook School

Compensation:

Will the First Releasor be receiving compensation?

Yes No

Enter the amount of compensation (e.g. 1,400.00):

Select the currency:

Select the method of payment:

Method of payment: