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RELEASE AND WAIVER OF LIABILITY AGREEMENT

Photo Release Form for Minors and Adults

The non-profit organization, Malama Hule‘ia, has my permission to use my or my child’s photograph publically to promote the organization. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

I, (the “Participant”), acknowledge that I have voluntarily applied to participate in the Mālama Hulē‘ia project (the “Project”), which Project will involve the cutting, clearing and eradication of non-native mangrove, restoration and re-vegetation in and adjacent to the Alakoko Fish Pond, Huleia River, Puali Stream, or Niumalu Park (the “Restoration Areas”). 

I AM AWARE THAT SOME OF THESE ACTIVITIES ARE HAZARDOUS ACTIVITIES AND THAT I COULD BE SERIOUSLY INJURED OR EVEN KILLED. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED AND AGREE TO ASSUME ANY AND ALL RISKS ASSOCIATED THEREWITH, INCLUDING, BUT NOT LIMITED TO, BODILY INJURY, DEATH, AND PROPERTY DAMAGE, WHETHER THESE RISKS ARE KNOWN OR UNKNOWN. 

I verify this statement by placing my initials here:

In exchange for being able to take part in Project activities, the undersigned Participant hereby irrevocably and forever releases and discharges Malama Hule‘ia, Okada Trucking Co., Ltd., the County of Kauai, all owners of lands that the undersigned Participant may traverse to access the Restoration Areas, and their respective trustees, officers, directors, employees, agents, and representatives (collectively, the “Released Parties”), from and against all claims and demands for loss or damage, including property damage, personal injury and wrongful death, arising out of or in connection with the undersigned Participant’s participation in the Project and entry on and use of the Restoration Areas. 

The undersigned Participant’s entry on the Restoration Areas and/or some or all of the activities that the undersigned Participant may participate in may be covered by Hawaiʻi Revised Statute (HRS Chapter 520) and, if so, this Release and Waiver will apply only to the extent that it may provide broader protections and releases to the Released Parties. The undersigned Participant also agrees to assume full responsibility for any injury or damage to his or her own person or to other persons or property that the undersigned Participant may cause. The undersigned Participant should not enter the water or marshy or muddy areas if the undersigned Participant has an open (or healing) wound which could enhance the risk of contracting leptospirosis, staph, or any other kind of flesh-eating disease which could cause death or permanent damage to the undersigned Participant. 

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE AND WAIVER OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE RELEASED PARTIES AND SIGN IT OF MY OWN FREE WILL.

Today's Date: November 22, 2019 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Participant's 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*
I would like to receive updates and event notification by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Ethnicity
**Some grants want us to collect this information**
African American
Asian
Hispanic
Native American
Native Hawaiian
White
Other
IF YOU ARE UNDER 18 YEARS OF AGE YOUR PARENT OR GUARDIAN MUST INITIAL ABOVE AND SIGN BELOW. If signed by Parent or Guardian: I verify that the dangers of the activities and the significance of this Release and Waiver were explained to the Participant and that the Participant understood them.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's 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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