NSSC Hanscom Access

APPLICATION FOR DBIDS IDENTIFICATION CREDENTIAL
(This Form is Subject to the Privacy Act of 1974)
PRIVACY ACT STATEMENT
Title 10, United States Code 8012 To assist security personnel in establishing a fitness determination through the identity proofing and vetting (background check) process. To request and record the issuance of computer generated HAFB Contractor/Visitor Identification Card and to request and record issuance of an identification credential when the use of another form has not been specified. Information requested on this form is voluntary. Failure to provide any of the requested information will result in non-issuance of the identification credentials.

I hereby authorize the use of and release of my personal information to the 66th Security Forces Squadron to accomplish a criminal background check for the purpose of determining eligibility for unescorted access to Hanscom AFB. I will promptly return all credentials when they are no longer needed for my assigned duties or upon request by proper authority. NOTICE: While on the installation all personnel and property under their control are subject to search.
To: 66 SFS/VCC
CONTRACTOR/BUSINESS REQUIRING ACCESS

Must Have Real ID - North Shore Swim Club
Are You A US Citizen*

YesNo
MR.MRS.MS.
NAME (Last, First, Middle)*
SOCIAL SECURITY NUMBER*
DRIVERS LICENSE/STATE ID NUMBER*
STATE*
DATE OF BIRTH (MM/DD/YYYY)*
PHONE NUMBER*
HOME ADDRESS*
REASON FOR ACCESS*
EMAIL ADDRESS:*
Swimmer Name*

First NameLast Name
Swimmer Name

First NameLast Name
Swimmer Name

First NameLast Name
Signature*

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Date*

MonthDayYear
Date
Copy of Drivers License*

Cancelof
Driver/Parents Name*

First NameLast Name
Date of Birth
Address Listed on License
I, ___ First Name Last Name _________________________ (print swimmers name),___ Date __/_____/_____(Swimmer’s DOB) in consideration for the use of the United States Air Force property and/or facilities, specifically for the use of the Hanscom AFB pool facilities from June 1st, 2025 (start date) to September 30th, 2026 (end date), do hereby agree to release and hold harmless any and all employees, officers, and/or agents acting on behalf of the United States Government and/or the United States Air Force from all liability, claims and demands of any person or entity which purport to have a claim against the United States as a result of or arising out of or in any way connected with use of the pool facilities or my presence on base to use the pool facilities. I fully understand and appreciate the risks associated with swimming, that my participation in the activity could result in injury or death, and I knowingly and voluntarily assume all risks associated with the activity. In addition, I agree to reimburse the United States for any damages I cause to Air Force property. Finally, I agree to indemnify the United States, its officers, agents, and employees for any and all liability arising as a result of or connected to my use of the Hanscom AFB pool facilities.
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As a sponsored guest on Hanscom Air Force Base we require that you adhere to the following policies:*

Obey posted speed limits (base max is 25mph road to pool is 20mph)Seatbelts must be wornCellphone use while driving is not permittedYour access permits you to drive to the POOL FACILITY ONLY. Roaming the base on foot or by car is not permitted. Use of track, playgrounds and ball fields not permitted.Park in a designated parking spot. Do not block walkway or parking lot entranceYou are not permitted to leave the building. You must remain in the pool building at all times.Ensure that a coach is at the pool prior to leaving your child unattendedFailure to comply with the base policy will result in your base privileges being revoked permanently.Type option 8Please also be aware that every evening at 5pm the loud speaker on base plays the National Anthem. Anyone that is walking or driving on base is required to stop until the Anthem is over.Type option 9
Signature of Participant (or guardian if under 18 or otherwise applicable *

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Swimmers Name*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

APPLICATION FOR DBIDS IDENTIFICATION CREDENTIAL

(This Form is Subject to the Privacy Act of 1974)

PRIVACY ACT STATEMENT

To: 66 SFS/VCC

CONTRACTOR/BUSINESS REQUIRING ACCESS