[location]

Name of Participant:_______________________________________________________________

Directorate/Program Number:_______________________________________________________

Name of Supervisor:_______________________________________________________________

Bldg Number:________________________ Job Title:____________________________________

Work Phone Number:_________________ Fax Number:_________________________________

E-mail address (if different than cc-mail):______________________________________________

AGREEMENT

I, ____________________________________________ , the Supervisor of the individual stated above, understand that he/she will be participating in the USACHPPM "Targeting Fitness" Civilian Health Promotion Program for three one-hour sessions each week for a total of 78 hours over the course of six months. I understand that participation will be the place of duty for the above mentioned individual, and that I agree to allow my civilian employee to attend during working hours for a time frame beginning __________ and ending __________. I also understand that the exercise periods are official duty time. Failure to use exercise time appropriately, or misconduct during these periods would be considered workplace infractions that would be subject to the same disciplinary actions. I also am aware that unused exercise hours of the participant may not be carried forward to subsequent weeks not can they be used for any non-duty purpose.