32 CFR Appendix A to Part 625, Dependent Travel Waiver of Liability

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Appendix A to Part 625 - Dependent Travel Waiver of Liability
“I _____________________
(Name of dependent)
will be accompanying _____,
(Name of employee)
who is my _________________
and who is an employee of _____,
(Agency, division)
on official Government business in or while using a Government vehicle. Dates of travel are from _____ to _____ 19__. I do hereby knowingly, freely and voluntarily waive any right or cause of action of any kind whatsoever, against the United States, arising as a result of such activity from which any liability may or could accrue while accompanying the above employee in or while using said Government vehicle.”
Signature of dependent
Notary Public