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RELEASE AND WAIVER

HAWAII ZIPLINE TOURS, LLC

P.O. Box 280, Honomu, HI 96728

NOTICE: THIS RELEASE AND WAIVER AFFECTS YOUR LEGAL RIGHTS.

PLEASE READ IT VERY CAREFULLY AND UNDERSTAND IT BEFORE YOU SIGN.

In consideration of the services HAWAII ZIPLINE TOURS, LLC, doing business as HAWAII ZIPLINE TOURS, LLC (the "Company") has agreed to provide to me, I hereby promise and agree on behalf of myself (or, if I am signing this document on behalf of a person who is under the age of eighteen, on their behalf as his/her Legal Guardian), and my heirs, assigns, personal representatives and estate (or those of the minor if I am his/her Legal Guardian) as follows:

1. I recognize and acknowledge that there are risks inherent in any activity. The same factors that contribute to enjoying an activity may also cause property damages, accidental injury, illness or, in extreme cases, serious injury or death. Having acknowledged that general risks exist, I hereby specifically accept and assume the following specific risks that may arise in participating in HAWAII ZIPLINE TOURS, LLC (the “Activity”): (a) my participation in the Activity may result in accidents, injury, serious injury and/or death; (b) such injuries or accidents may occur in remote places where there are no immediately available medical facilities; (c) during the Activity I may experience fatigue, extreme heat, chill and/or dizziness which may diminish my reaction time and that of others and may therefore increase the risk of accident; (d) changing weather, fog, rain, sleet and/or other conditions, slippery trails and/or roads, falling rocks, and erosive cliff edges through or near which I will be walking and/or traveling, my own inability to properly participate in the Activity or to follow rules and directions concerning the Activity and unforeseeable events may all contribute to the chances of accident and/or injury.

                                                                                                                                 

2. I hereby confirm that I am at least eighteen years of age or my legal guardian will be participating with me in the Activity, that I am physically and mentally capable of participating in the Activity, that I will comply with all of the instructions and safety requirements for participating in the Activity, that I am capable of using the equipment provided to me by the Company, and that I am participating in the Activity voluntarily and of my own free will. I acknowledge that I will be required to listen to and follow rules and guidelines for participating in the activity, including but not limited to the following:

  • I will abide by all instructions provided to me by the Company, and the Company’s designated tour guides
  • I will not make any adjustments to my equipment, and I agree that all adjustments will be made only by or with the assistance of a Company tour guide
  • I will not intentionally flip myself over or invert myself while on the zipline
  • I will hold on with at least one hand at all times while zipping

                                                       

3. I understand and agree that the Company reserves the right, in its sole discretion, to refuse to permit me to participate in the Activity, and that the Company may terminate my participation in the Activity if it believes me to be incapable of following the instructions or meeting the safety requirements or the rigors of participating in the Activity. I specifically agree to release the Company from any liability if I am prevented from participating in the Activity for any reason whatsoever.   

                                                                                                                                                                            

4. I hereby agree to assume full responsibility for myself and anyone else over whom I am legal guardian, for bodily injury, death or damages incurred as a result of my participation in the Activity. I further agree to defend, indemnify and hold HAWAII ZIPLINE TOURS, LLC, RICHARD E. ALDERSON INTER VIVOS TRUST, JOHN K. SMITH and PAMELA G. SMITH, and their agents, employees, officers, and owners harmless from any liability WHATSOEVER for any bodily injury, death, loss of personal property or expenses resulting from my participation in the Activity.

  

5. I hereby agree and confirm that any claim, action or dispute arising under this agreement or as a result of my participation in the Activity shall be commenced in the Third Circuit Court of the State of Hawaii.

I have read and understand and hereby accept the terms and conditions stated in this Release and Waiver.

Date: September 17, 2021

First Guest's Name

First Name*

Last Name*

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

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
First Guest's Signature*
Second Guest's Name

First Name*

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

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
Third Guest's Name

First Name*

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

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
Fourth Guest's Name

First Name*

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

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
Fifth Guest's Name

First Name*

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

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
Sixth Guest's Name

First Name*

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

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
Seventh Guest's Name

First Name*

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

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
Eighth Guest's Name

First Name*

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

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
Ninth Guest's Name

First Name*

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

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
Tenth Guest's Name

First Name*

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

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
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*
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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

WEIGHT: *
ARE YOU PREGNANT?*
DO YOU HAVE ANY BACK/KNEE/ANKLE/JOINT OR OTHER MEDICAL CONDITIONS WE SHOULD BE AWARE OF (including recent surgeries or injuries)*

If so, what are they:
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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