Hold Harmless Information Form

      Hold Harmless Information Form

      Directions: Complete all of the information requested on this electronic form and click submit below. The Office of Environmental Health, Risk Management & Safety will prepare the Hold Harmless using the information you provide. Please try to keep responses as brief as possible. If you experience difficulty using this form or have any questions, please call 472-1856. Thank you.

      **Please Note: This is for UW-Whitewater use only**

       Type of Activity (Please give as much information as possible): 

      Location of Activity:

      Date of Activity:

      Sponsoring Organization or Department:

      Contact Information(Required):

      Name of Contact Person:
      Campus Phone Number:
      Local Email Address:


      Office of Administrative Affairs 
      330 Hyer Hall
      800 West Main Street
      Whitewater, WI 53190