Free Hold Harmless Agreement Template 33
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RELEASE AND HOLD HARMLESS AGREEMENT
1. PRIVACY ACT STATEMENT: Personal data is solicited under authority of 10 USC 3012 and AR 27-40. The
information is for use to determine eligibility for voluntary participation in activity of Wisconsin Drug Control
Program in the area of Volk Field ANGB and/or Ft McCoy to include all Volk Field and/or Ft. McCoy used
facilities. Disclosure of requested information is voluntary, but failure to disclose all or any part of it may result in
denial of permission to participate in such activities for training hosted by Wisconsin Drug Control Program
during your training period.
2. PERSONAL DATA:
NAME _______________________________________________________ AGE ____________
FIRST
MIDDLE
LAST
ADDRESS______________________________________________________________________
CITY
STATE
ZIP
Person to be notified in case of emergency ___________________________________________
Relationship ____________________________________________________________
Address _________