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Lokahi OCC

Realease of Liablity Waiver

In consideration of the services of Lokahi Outrigger Canoe Center, their Agents, Owners, Officers, Volunteers, Participants, Employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as 'L.O.C.C."), I hereby agree to release and discharge L.O.C.C, on behalf of myself, my children, my parents, my heirs, assigns, personal representatives and estate as follows:


1. I acknowledge that my participation in paddling an outrigger canoe entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.

The risks include, among other things: boat capsize and entrapment; tidal conditions and currents; travel in remote areas; collision with
objects or other watercraft; prolonged exposure to cold water, hypothermia, accidental drowning; illness in remote areas; exposure to sun, dehydration, heat exhaustion, heat stoke, heat cramps, strong wind, cold, storms, large waves, eddies and whirlpools, and lightening; aggressive and/or poisonous marine life, wrist, arm, shoulder, and/or back injuries: slips and falls while hiking; and rapidly changing adverse weather and water conditions. Canoes are slippery when wet and accidents can occur getting in or out of the canoes.

Furthermore, L.O.C.C. Coaches and Staff have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather, the elements, or the terrain. They may give inadequate warnings or instructions, and the equipment being used might malfunction.

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless L.O.C.C. from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of L.O.C.C.s equipment or facilities, including any such claims which allege negligent acts or omissions of L.O.C.C.

4. Should L.O.C.C. or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I have no medical or physical conditions which could interfere with my safety in this activity, or else I am willing to assume - and bear the costs of -- all risks that may be created, directly or indirectly, by any such condition.

6. In the event that I file a lawsuit against L.O.C.C., I agree to do so solely in the State of California, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against L.O.C.C. on the basis of any claim from which I have released them herein.
I have had sufficient opportunity to read this entire document I have read and understood it, and I agree to be bound by its terms.

 

First Adult Name

First Name*

Middle Name

Last Name*

Phone*
First Adult Date of Birth*
First Adult Signature*
Second Adult Name

First Name*

Middle Name

Last Name*
Second Adult Date of Birth*
Third Adult Name

First Name*

Middle Name

Last Name*
Third Adult Date of Birth*
Fourth Adult Name

First Name*

Middle Name

Last Name*
Fourth Adult Date of Birth*
Fifth Adult Name

First Name*

Middle Name

Last Name*
Fifth Adult Date of Birth*
Sixth Adult Name

First Name*

Middle Name

Last Name*
Sixth Adult Date of Birth*
Seventh Adult Name

First Name*

Middle Name

Last Name*
Seventh Adult Date of Birth*
Eighth Adult Name

First Name*

Middle Name

Last Name*
Eighth Adult Date of Birth*
Ninth Adult Name

First Name*

Middle Name

Last Name*
Ninth Adult Date of Birth*
Tenth Adult Name

First Name*

Middle Name

Last Name*
Tenth Adult Date of Birth*
Adult Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Health and Swimming Questionnaire
Do you wear a Medic Alert Bracelet*
No
Yes
Can you swim*
No
Yes
If yes, how well do you swim?*
Fair
Good
Excellent
non-swimmer
Can you tread water for 3 minutes?*
No
Yes
More than 3 minutes*
No
Yes
Are you currently CPR certified? Select one option:*
CPR
CPR/First Aid
CPR/First Aid/AED
First Aid
Heart Defibrillator/AED
None of the above

Do you have any medical conditions(s) we should know about? (Asthma, HBP, Heart Condition, Heat or Sun Sensitivity) *If none, please put NONE or N/A in boxes. *

Do you take any medication for the above listed condition(s) or any other medication we should know about? Please list below: *

Are you allergic to any medications? If yes, please explain. *
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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