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After School Program

Liability Waiver and Photo Release Form


Grow Some good is a Maui based non-profit organization supporting agricultural education in Hawai‘i’s schools and communities. Weʻre so excited to have your keiki in the garden with us! 

First Parent/Guardian Name
First Name*
Last Name*
Phone*
First Parent/Guardian Age Acknowledgment*
First Parent/Guardian Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Parent/Guardian Signature*
Second Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Third Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Fourth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Fifth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Sixth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Seventh Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Eighth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Ninth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Tenth Parent/Guardian Name
First Name*
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Allergies
Please list any allergies your child has here, if none please leave blank.
Photo Release
I grant permission to Grow Some Good to photograph and/or record my child during participation in the after-school garden program. I understand that these photos or recordings may be used for educational, promotional, and outreach purposes in various media, including but not limited to websites, social media, publications, and presentations. I release and hold harmless Grow Some Good, its staff, affiliates, and any partnering organizations from any claims or liability related to the use of my child's image or likeness. I agree that no compensation will be provided for the use of these photos or recordings.*
Yes
No

Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

By signing this form, I acknowledge that I am voluntarily allowing my child to participate in the after-school garden program hosted by Grow Some Good. I understand that while the program takes reasonable precautions, there are inherent risks involved with outdoor activities, including but not limited to exposure to insects, plants, weather conditions, and the use of gardening tools. I release and hold harmless Grow Some Good, its staff, affiliates, and any partnering organizations from any liability, claims, or damages that may arise from my child's participation. I agree to assume all risks and responsibility for any injury or harm my child may experience during the program.



By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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