Between Camp Wyanokie Commission and _____________________________


         WITNESSETH:   ___________________________________ agrees to release,


         indemnify and hold harmless the CAMP WYANOKIE COMMISSION, IT’S


         EMPLOYEES, AGENTS OR VOLUNTEERS from any loss, damage and liability,


         including attorneys’ fees and expenses incurred by the latter arising out of or in


         consequence of the use of the Camp Wyanokie site and facilities. The applicant


         has been requested to furnish a Certificate of Insurance with limits of liability


         described below:    Please indicate amount of coverage.


         Workers Compensation/Employers Liability: _____________________________


         Automobile Liability: ________________________________________________


         Umbrella Liability: __________________________________________________


         A true copy of the Certificate of Insurance is attached.



         Date  ___________________           Signature  ___________________________