FREE Canadian Release of Accident Claim

A free Release of Accident Claim for use in Canada used by a party to release another party of all claims and damages resulting from an accident.

Disclaimer:This was not drafted by an attorney & should not be used as a legal document.


IT IS AGREED BETWEEN THE PARTIES TO THIS AGREEMENT THAT FOR AND IN CONSIDERATION OF THE SUM OF CAD $ [Amount] in the form of cheques or drafts payable as follows:

Cashiers cheque from [Name]cheque number [Number] to [Name] as payee, which sum shall be deemed to have been paid upon the delivery of such drafts or cheque to the undersigned, and on behalf of all and each of the heirs, executors, administrators, successors and assigns of the undersigned, (hereinafter referred to as "Releasors") hereby releases and forever discharges [Name of the Releasee] of and from any and all claims, demands, damages, actions and causes of action of every kind, known and unknown, including but not limited to any and all claims for, personal injuries, or property damage, including but not limited to loss or destruction of, or damage to, baggage, and any and all other claims in any way connected with an accident which occurred on [Date of the Accident] at [Place].

[One may also give a brief paragraph of the narration about the event of accident]

IN FURTHER CONSIDERATION of the above mentioned sum, the undersigned agrees as follows:

1. There is a risk that subsequent to the execution of this release the undersigned will incur or suffer personal bodily discomfort, monetary or other loss, death, damage or any of these which are in some way caused by or related to the occurrence referred to above, but which are unknown and unanticipated at the time this release is signed.

2. The undersigned shall assume the above mentioned risks, and this release shall apply to all unknown or unanticipated results of the occurrence described above as well as those known and anticipated.

3. The above mentioned sum is the entire and only consideration for this release and there shall be no further or future consideration payable by the Releasor to the Releasee.

4. It is intended by Releasors and Releasees, that this release shall be complete and shall not be subject to any claim of mistake of fact or law by the undersigned, and that it expresses a full and complete settlement of liability claimed and denied. 5. This release is the result of a compromise of a disputed claim and shall never at any time for any purpose be considered as an admission of liability or responsibility of the parties hereby released.

5. This settlement is in complete satisfaction of any and all claims and counterclaims arising from the incident in question.

6. It is the express intent and understanding of the Releasors and Releasees that any and all rights of indemnity and/or contribution or other derivative claims that any Releasee may have against any other Releasee or Releasees or other persons, firms or entities shall be preserved by the execution of this release. It is agreed and stipulated by the undersigned that the amount paid in consideration for this release is a fair and reasonable settlement.

IN WITNESS WHEREOF, I have hereunto signed my name and affixed my official seal this date.

Parties to the Release Deed:



The forms on this site are provided "As-Is." By using these forms you agree that you are using them at your own risk. Most of the free forms are not prepared by an attorney and may need substantial modification. Additional disclaimers can be found in our Terms of Use.