FINANCIAL LIABILITY AGREEMENT AND CONSENTFinancial Liability Agreement • November 12th, 2013
FINANCIAL LIABILITY AGREEMENT WORKER’S COMPENSATIONFinancial Liability Agreement • June 21st, 2005
I, have been advised that should my Worker’s Compensation carrier deny my claim my health insurance carrier will be billed for all services. If I do not have health insurance I will be responsible for all balances.
bradysbouncers@gmail.comFinancial Liability Agreement • November 20th, 2013
FINANCIAL LIABILITY AGREEMENT WHEN YOU REGISTER FOR CLASSES I UNDERSTAND:Financial Liability Agreement • March 3rd, 2022
Applies to 2021SU, 2021FA, and 2022SP terms FINANCIAL LIABILITY AGREEMENT WHEN YOU REGISTER FOR CLASSESFinancial Liability Agreement • March 15th, 2021
Agreement to Financial LiabilityFinancial Liability Agreement • December 9th, 2019
ContractFinancial Liability Agreement • November 3rd, 2003
AGREEMENT OF FINANCIAL LIABILITY - IC 9-24-9-3, 4, 5(To be used if applicant is under 18 years of age) Notice: If the applicant is under the age of 18, the following statement must be signed and sworn to or affirmed (before a person authorized to administer oaths) by the father or mother or guardian having custody. In the event neither parent is living within the state and the applicant has no guardian, this statement may be signed by the person having custody of the applicant or by an employer of said applicant and in the event there is no parent, guardian, or employer, then by any other responsible person willing to assume the obligations imposed by this statement. (herein minor)has applied for a driver license or a learner permit.* The undersigned AFFIANT hereby agrees to be responsible, jointly *and severally with the MINOR for any injury of damages which saidMINOR may cause, by reason of operation of a motor vehicle, in such cases as the MINOR is found to be liable for such injuri
FINANCIAL LIABILITY AGREEMENT WHEN YOU REGISTER FOR CLASSESFinancial Liability Agreement • March 2nd, 2020
ContractFinancial Liability Agreement • June 2nd, 2013
Agreement to Financial LiabilityFinancial Liability Agreement • January 10th, 2020
