This section shall be known as the "Minor Settlement Proceedings Reform Act".
I, .........., the [guardian or other person authorized to execute the release] of .........., a minor, in consideration of the sum of $.........., and under authority of an order of the Circuit Court of .......... County, entered on the .......... day of .........., 20....., pursuant to West Virginia Code 44-10-14, do hereby release .......... from all claims and demands on account of injuries allegedly inflicted upon the minor and any property of the minor on the .......... day of .........., .........., at .............................................
______________(Signature)_________________
[Guardian or other person authorized by the court to execute the release] of .......................
W. Va. Code § 44-10-14