To: Release executed on the ______________ day of ________ (year)

by _________________________________ (the 'Releasor')

of _________________________(State), to ____________________________ (the 'Releasee')

of ________________________________________________ (property)

I, the Releaser, being of lawful age, in consideration of being permitted to participate in
(explain Activity) _____________________________________________________________________. (scheduled for) ________________________________________________ and monitored by the Releasee, WAIVE, RELEASE, and DISCHARGE the Releasee, his heirs, executors, administrators, legal representatives and assigns from all liability for or by reason of any damage, loss or injury to person and property, even injury resulting in the death of the Releaser, which has been or may be sustained in consequence of the Releaser's participation in the activity described above, and notwithstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Releasee.

Signed by Releasor'______________________________

Signed by Releasee'______________________________

Witness________________________________________