KNOW ALL MEN BY THESE PRESENTS: I, 
am this date about to 
craft; and whereas, I 
Place) 
(Cat ej 
(Full Name) 
take a flight or flights as a passenger in certain Army air- 
- .- 7 - ™ doing so entirely .upon my own initiative, risk, and 
responsibility; now, therefore, in consideration of the permission extended to me 
by the United States through its officers and agents to take said flight or flights, 
do hereby for myself, my heirs, executors, and administrators, remise, release, 
and forever discharge the Government of the United States, and all of its officers 
and agents, a cting officially or otherwise . from any and all claims, demands, 
actions, or causes of action, on account of my death or on account of any in.iurv to 
me which may occur by reason of the said flight or flights. 
The term " fl i ght or flights" as used herein is understood and agreed to include the 
preparation for, continuation, and completion o£ flight or flights as well .as all 
g ppnd gnd f l i ght operations incident thereto . It is further understood and agreed 
LMt this re lease , among other things extends to and includes negligence , faulty 
pilotage , and structural failure of the aircraft thereof . The execution hereof 
aoes not o perate to waive any statutory right conferred by act of congress . 
(j. 
(Signature) 
_ Qa, _ 
(Name of ^tson toVbe notified in emergency) 
^Address of person to be notified in emergency )J ' (Witness) 
The signed release card will be attached to the authorization for the flight or 
lights and carefully filed by Commanding Officers for future reference. A sep¬ 
arate release will be signed for each day’s flight or flights. 
