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Company Name ("Grantor") is releasing First Last ("Grantee") from all known claims, damages, liability or other obligations arising prior to the date on this Agreement.

I, the undersigned, residing at Contract Address, do hereby consent to release First Last from all claims or obligations known or unknown for the following:

Insert the scope of the release, incident or claim of liability - including dates. I further attest that I have not assigned any of my rights concerning any claims or obligations covered under this agreement to any third party or individual. I further agree that this release shall bind myself and my successors. In witness whereof, the parties have executed this Agreement this Current Day day of Current Month, Current Year.

Job title of signator, authorized signature or signer.

Date of Agreement: