This is what I have worked up so far. Borrowed, sliced, diced and spliced from other web sites, and put into something usable by me. Please feel free to borrow for your own use. Improvements are encouraged. I still need to call OOIDA and see if they have a cookie cutter form that would replace my work. Didnt see one on their website in the forms section.
PASSENGER RELEASE, INDEMNIFICATION AGREEMENT AND RIDER AUTHORIZATION
The undersigned, being of lawful age, and with knowledge of the hazards involved in the transportation industry, hereby voluntarily agrees and/or represents as applicable:
1. That in exchange for free transportation on a company owned vehicle or driver leased vehicle, the undersigned (hereinafter Passenger) hereby releases and forever discharges ___company name___, its affiliates and subsidiaries, officers and employees from any and all claims, losses, injuries or damages, including personal injury or death, resulting directly or indirectly from the Passengers presence as a passenger on a ___company name____ truck.
2. Passenger agrees to indemnify, defend and hold ____company name____ harmless from any injury or loss resulting to _______company name______ or any third party arising from the Passengers presence on any Company owned or Driver leased vehicle.
Passenger Information: (please print legibly)
Name: ________________________________________
Address:______________________________________
Date of Birth: ______________________
_____________________________________________
Emergency Contact Name and Phone Number:
I the undersigned acknowledge that I have fully read this agreement understand its content and have voluntarily signed below.
___________________________________ _________
Passenger Signature (if over the age of 18.) Date
I hereby authorize this passenger.
Authorized by:____________________
Signature: _______________________
Ending Date: _____________________
.
Leave a Reply