3. DECLARATION:
I desire to participate at my own risk in the activity described above. I represent that I will take all safety precautions necessary thereto, assuming sole and full personal responsibility for ensuring that all safety requirements are met to my personal satisfaction prior to my active participation in such activity. I state that I am in good health, physically fit to engage in this activity, and have no known medical condition that could jeopardize my safety during such participation or be aggravated by such participation. I understand that the United States, the Commonwealth of PA, the Northeast Counterdrug Training Center, their officers and employees, will not be liable for personal injury, illness, death, and property damage, costs, charges, claims, demands and liabilities of whatever kind, name or nature in any manner arising out of or in connection with my participation in the indicated activity. This is not a waiver of any workers’ compensation coverage, medical benefits or treatment, which I am entitled to receive as an employee of my agency or other applicable medical coverage, nor does this statement subject any government party (U.S. Government, Commonwealth of Pennsylvania, NCTC, employees, officers, successors and assigns) to any liability not expressly authorized by law. I understand and agree that I may be held personally liable for any damage or loss to the United States Government or the Commonwealth of PA that is caused by my negligence or misconduct, while participating in this activity. I further understand that any and all buildings at Fort Indiantown Gap may contain lead paint and/or asbestos and willfully accept any responsibility or possible danger associated with those elements.