WAIVER AND RELEASE OF LIABILITY
In consideration of being under the employ and/or performing services for, and being
allowed to participate in any of the activities of _________________ (the “Law Firm”), the
undersigned states and agrees to the following:
1. I am currently on leave for ______ days from ___________ to _________________
due to ______________________. I am expected to report back to work on
_________________________, in accordance with my doctor’s advise to rest for
______ days.
2. However, I wish to report back to work or work from home (WFH) on an earlier date,
or on __________________.
3. Returning to work on an earlier date/ working from home is entirely of my own
volition and free will.
4. I hereby assume all risks and dangers and all responsibility for any losses and/or
damages that may arise from my early return to work/ WFH.
5. I hereby release, defend, indemnify and hold harmless the law firm from and against
any claims, damages or liability arising from or related to my early return to work.
6. I am of legal age and competent to contract in my own name. I have read this
document before signing below, and I fully understand the contents, meaning and
impact of this waiver and release of liability. This consent, waiver, indemnity and
release is binding on me, my heirs, and executors.
7. I certify that I agree to and understand the terms of this waiver and release of liability
and that I voluntarily and willingly executed this waiver and release of liability with
full knowledge of my rights under the law.
__________________________________ ________________________
Signature over printed name Date