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RELEASE OF LIABILITY AND ASSUMPTION OF RISK

 

Note:  If you have previously completed a signed waiver, please proceed to step 2- schedulng:

https://fareharbor.com/embeds/book/paliclimbingwall/?full-items=yes

 

     This form must be signed with NO additions, deletions or changes, for the participant to take part in the Kauai Team Challenge Inc. course activities.  We want to make sure you understand the risks in Kauai Team Challenge Inc. course activities and have carefully thought through whether you want to participant. 

RELEASE FORM:  The Kauai Team Challenge Inc. (Herein after collectively referred to as KTC) rock climbing wall involves physical activity in an outdoor setting.  It includes climbing, jumping, and other rigorous activities both known and unknown on natural and man-made structures that are on the ground or at low, medium or high distances from the ground.  It is possible that you may be injured while participating in the program. We want to make sure that you understand the risks of injury before you decide to participate.  It is required that you read the following very carefully, make sure you understand it and sign it before you begin the program. 

  1. I ACKNOWLEDGE THAT THE ACTIVITIES INVOLVED IN THE USE OF ANY OF KTC’S SERVICES OR FACILITIES, AT THIS LOCATION AND ALL OTHER LOCATIONS, BOTH CLIMBING AND NON-CLIMBING RELATED, ENTAIL SIGNIFICANT RISKS, BOTH KNOWN AND UNKNOWN, WHICH COULD RESULT IN PHYSICAL OR EMOTIONAL INJURY, PARALYSIS, DEATH, OR DAMAGE TO MYSELF, TO PROPERTY, OR TO THIRD PARTIES.  SUCH RISKS INCLUDE, AMONG OTHERS, EQUIPMENT FAILURE, FALLING CLIMBERS, AND NEGLIGENCE OF BELAYERS AND OTHER PARTICIPANTS.
     
  2. I AM FULLY AWARE THAT I AM CHOOSING TO PARTICIPATE IN INCLUDES RIGOROUS PHYSICAL ACTIVITIES.  I AM ALSO AWARE THAT THERE ARE RISKS OF PHYSICAL INJURY, OR HARM FROM PARTICIPATING IN THE KTC ROCK CLIMBING WALL.  I VOLUNTARILY ELECT TO PARTICIPATE IN THE PROGRAM AND TO ACKNOWLEDGE THAT AT ALL TIMES; MY PARTICIPATION IS MY OWN CHOICE. 
     
  3. I ASSUME THE RISKS OF INJURY OR HARM THAT COULD RESULT FROM PARTICIPATION.  ON MY OWN BEHALF, AND ON BEHALF OF MY PERSONAL REPRESENTATIVES, AND HEIRS, I HEREBY FOREVER RELEASE KTC AND ALL IT’S OFFICERS, EMPLOYEES, CONSULTANTS, AGENTS, AND DIRECTORS, AND VOLUNTEERS FROM ALL LIABILITY FROM ANY INJURY OR HARM TO ME FROM PARTICIPATING IN THE KTC CLIMBING WALL; WHETHER THE INJURY OR HARM IS CAUSED BY THE NEGLIGENCE OF KTC OR OTHERWISE.  BY SIGNING THIS DOCUMENT, I AM WAIVING MY RIGHT TO MAINTAIN A LAWSUIT AGAINST THE ABOVE MENTIONED ON THE BASIS OF ANY CLAIM.
     
  4. SHOULD KTC OR ANYONE ACTING ON THEIR BEHALF BE REQUIRED TO INCUR ATTORNEY’S FEES AND COST TO ENFORCE THIS AGREEMENT, I AGREE TO INDEMNIFY AND HOLD THEM HARMLESS FOR ALL FEES AND COSTS. 
     
  5. I AGREE TO ABIDE BY THE RULES OF KTC.
  6. IN CONSIDERATION OF MY PARTICIPATION IN THE PALI ROCK CLIMBING WALL, BY KAUAI TEAM CHALLENGE INC. AT KUKUI GROVE CENTER DO HEREBY RELEASE AND FOREVER DISCHARGE THE KUKUI GROVE CENTER INVESTMENT GROUP INC., HEITMAN CAPITAL MANAGEMENT LLC; JONES LANG LASALLE AMERICAS, INC.; AND THEIR AFFILIATES, PARENTS, SUBSIDIARIES, OFFICERS, DIRECTORS, AGENTS, EMPLOYEES, SHAREHOLDERS AND ASSIGNS FROM ANY AND ALL CLAIMS, DEMANDS, CAUSES OF ACGIONS, SUITS, DAMAGE COSTS AND EXPENSES FOR ANY AND ALL PERSONAL INJURIES, LOSS OF TIME, PAIN AND SUFFERING OR PROPERTY DAMAGE ARISING OUT OF OR OCCURRING IN CONNECGTION WITH MY PARTICIPATION. 

  7. I WILL COMPLY WITH ALL APPLICABLE LAWS AND GUIDELINES IMPLETEMENTED BY THE AUTHORITIES HAVING JURISDICTION WHERE THE PROPERTY IS LOCATED AS A RESULT OF THE NOVEL CORONAVIRUS (COVID-19) PANDEMIC.  THESE LAWS AND GUIDELINES THROUGHOUT THE DURATION, INCLUDING SET UP AND TAKE DOWN. 

 

Dated: September 17, 2021

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
Third Participant's Name

First Name*

Middle Name

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

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
Fourth Participant's Name

First Name*

Middle Name

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

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
Fifth Participant's Name

First Name*

Middle Name

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

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
Sixth Participant's Name

First Name*

Middle Name

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

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
Seventh Participant's Name

First Name*

Middle Name

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

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
Eighth Participant's Name

First Name*

Middle Name

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

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
Ninth Participant's Name

First Name*

Middle Name

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

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
Tenth Participant's Name

First Name*

Middle Name

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

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
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*
Check to receive information, news, and discounts by e-mail.
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 Information

Survey (for ages up to 21 years of age)

How do you spend your time outside of school? Please check ALL that apply
Homework
Helping your family
Hanging out with friends
Physical exercise (surfing, basketball, weights, etc.)
Chilling (listening to music, napping, watching videos, reading, etc.)
Social media
Job
Other (please list below)
How has Covid-19 affected your life (check all that apply)
not too bad
added stress
miss my friends and hanging out
too much online school
other (list below)
Please rate your current level of stress

WHEN YOU HAVE HAD A PROBLEM OR SOMETHING HAS GONE WRONG, WHAT DID YOU DO? 

1. You tried to think of different ways to solve the problem
2. You thought about what others might do
3. You tried your best to make things better
4. You avoided the problem
5. You asked someone for help
6. Were you able to fix the problem
7. You did things to stop thinking about it
8. If it was your fault you would say that you were sorry
Has social media added to your anxiety or caused more stress in your life?
If so, in what ways has social media caused more stress in your life? Please check ALL that apply)
Less sleep
Less ability to focus or concentrate
Anxious about missing out on things
Worried about what people are saying or thinking about you
Other (please list below)
Do you have at least one caring and supportive adult in your life that you can talk to?
How often do you get to participate in physical exercise activities?

What kinds of afterschool activities are you most interested in?
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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