ATLANTA POLICE DEPARTMENT

CVSA Truth Verification Release Form

I,___________________________________ , do hereby voluntarily, without duress, coercion, promise, reward, or immunity, consent and submit to an examination by the Computer Voice Stress Analyzer truth verification technique. I hereby release, absolve and forever hold harmless, Atlanta Police Department, its servants, agents, and anyone acting on it’s behalf from any and all claims, demands or other damages from any matter, act, or thing arising out of aforesaid examination.

I understand that this examination may be video taped and/or audio taped and I release into the possession of the Atlanta Police Department, all materials, recordings, and all other documents for the purpose of testimony and/or training. I understand that this examination is a public record.

__________________________________	________________________

Signature	Date

__________________________________	________________________

Witness	Date

__________________________________	________________________

Signature of Parent/Guardian	Date

if under 17 years

Form APD 338 9/17/03

ATLANTA POLICE DEPARTMENT

AJordan

2004-01-07

Atlanta Police Department