A The Steam Team representative has advised me that there are areas in the structure mentioned below 

which are wet and/or contaminated, or which could become contaminated. The Steam Team’s 

representative has recommended certain procedures that include the following: 


I have voluntarily chosen to refuse to allow The Steam Team to perform the procedures that have 

been described to me, and do so with full knowledge of the potential risks. I hereby accept full 

responsibility and liability for any and all consequences of my refusal. 

I understand that by refusing the services, the property may become biologically contaminated and that 

substantial additional damage may occur. Mold, fungi and/or bacteria could grow in or around the 

carpet, padding, walls, cabinets, and elsewhere within the structure, causing further property damage 

and/or resulting in a "sick" building which may be a health hazard. I have been directed to the EPA’s 

website and specifically the topics Introduction to 

Molds, Basic Mold Cleanup, Ten Things You Should Know About Mold, Asthma and Mold,

Floods/Flooding, Health and Mold, Homes and Mold, Indoor Air Regulations and Mold, Large 

Buildings and Mold, Schools and Mold and Indoor Air Quality, Other Mold-Related 

Resources/Links discussing mold, Sick Building Syndrome and its causes and prevention. I understand 

that the problems which may result include, but are not limited to toxic, allergic and inflammatory 

illness and disease, as well as structural and aesthetic damage such as warping, decay and dry rot.

Accordingly, I waive any and all potential claims that I may have against The Steam Team now or in the 

future, for damages, illnesses or any other type of harm that may result from my refusal of the 

recommendations that have been described to me I further agree to release, hold harmless, defend (pay 

attorneys' fees), and indemnify The Steam Team against any and all claims or actions now, or at any time 

in the future, which may result from my refusal of any of the recommended procedures that have been 

described to me I execute this Release voluntarily and without duress or coercion 


Print Owner/Agent Name:___________________________________________________________ 

Property Address:__________________________________________________________________ 

I have read, understood and agreed to the statements and terms above. 

Owner/Agent Signature:_____________________________________ Date:_________________ 

Print Witness Name:_________________________________________________________________ 

Witness Address:____________________________________________________________________ 

Witness Signature:__________________________________________ Date:________