Hold_Harmless_Agreement.pdf

ADULT - HOLD HARMLESS AGREEMENT

AEDC Public Affairs Industrial Area Tour

In consideration for me being allowed to tour the AEDC industrial area, I, the undersigned, intending to be legally bound, agree as follows:

1) To forever release and discharge the United States, its agencies, agents, and authorized personnel as hereinafter defined, from every liability arising out of, or in connection with the above-referenced activity, or in going to, departing from, or being within the confines of Arnold Air Force Base, I, the undersigned person hereby waive and release for myself, my heirs, executor and administrators, any and all rights and claims for damages, demands and any other actions that have resulted from my participation in the above-referenced tour, which I may have against the United States Air Force, the US Government, and all other such agencies, agents, and persons, including the costs of suit, attorneys’ fees, and other expenses in connection therewith.

2) I agree to hold these entities, and their agents, representatives, successors, and assignees harmless from any liability including any and all injuries, to include death, that are suffered by me as a result of participation in this tour.

3) For the purposes of this agreement, the term “authorized personnel” shall include: a) civilian and military personnel of the United States acting within the scope of their employment, or in the line of their duty; b) independent contractors, subcontractors, and personnel of independent contractors and subcontractors with the United States, acting within the scope of their employment, if such employment is for the purpose of constructing, operating, maintaining, or improving Air Force installations or facilities; and c) heirs, successors, executors, administrators, and assigns of agents of the United States and of personnel noted in clauses (a) and (b) of this paragraph.

X Signature of Participant Printed Name of Participant Date

ARE YOU:

U.S. Citizen: YES NO (Please Circle)

If no, please provide citizenship: ____________________

If citizenship is somewhere other than the U.S. or participants hold dual citizenship, please provide one of the following: LPR #, student or work VISA # or Passport. A COLOR copy of such documentation must accompany the roster and must be submitted at least 14 working days prior to the tour date.

Hold Dual Citizenship: YES NO (Please Circle)

If yes, please provide citizenships: ____________________

Employee of a Foreign Owned Company: YES NO (Please Circle)

If yes, please provide name of company and country of origin: ____________________

REV.01/2014