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DEPARTMENT OF PARKS & RECREATION (DPR)
COUNTY OF MAUI
Wailuku, Maui, Hawaii

PARENT’S/GUARDIAN’S RELEASE, ACKNOWLEDGEMENT AND
INDEMNIFICATION ON BEHALF OF MINOR

IN CONSIDERATION of the permission and privilege granted by the COUNTY OF MAUI toTBD, a minor child whose date of birth is TBD (hereinafter referred to as the “Minor”), to participate in the: Shredsgiving Skate Event on Saturday, November 30, 2024 at the Mayor Hannibal Tavares Complex Skate Park (hereinafter referred to as the “Activity”), jointly conducted by the Department of Parks and Recreation (DPR) of the County of Maui and One Love Skate, (hereinafter collectively referred to as the “Event Organizers”), the undersigned parent or guardian of the Minor (hereinafter referred to as “Parent”) agrees as follows:

1. Parent acknowledges and understands that the Activity may involve physical contact, and may result in bodily injury or property damage to the Minor. Parent further acknowledges and understands the risks associated with Minor’s participation in the Activity and is fully aware that there may be unforeseen risks associated with Minor’s participation in the Activity. The Minor’s participation in the Activity is entirely voluntary and the Minor may decline to participate at any time.

2. Parent agrees to defend, indemnify, and hold the Event Organizers, their officers, employees, agents and servants harmless from and against any and all losses, liability, claims and demands for personal injury, death, illness such as, but not limited to, COVID-19, and/or property damage arising out of or in connection with the Minor’s participation in the Activity, and Parent further agrees to reimburse the Event Organizers for all costs, expenses, charges, including reasonable attorney’s fees, in connection with any defense or judgment of any such claim.

3. Parent agrees to defend the Event Organizers in any litigation in which the Event Organizers are made a party, arising out of the Minor’s participation in the Activity, and Parent further agrees to reimburse the Event Organizers for all costs, expenses, charges, including reasonable attorneys’ fees, incurred in connection with any defense or judgment resulting out of any such litigation.

4. Parent herein releases the Event Organizers, their officers, employees, agents and servants from and against any and all claims, demands and/or causes of action that Parent, on behalf of the Minor, may have for property damage, personal injury, or death arising out of or in connection with the Minor’s participation in the activity.

5. Parent confirms that the Minor is covered by medical insurance to pay for expenses that may be incurred due to personal injury to the Minor’s participation in the Activity.

6. Parent gives permission to have the Minorrecorded, photographed and/or videotaped in connection with the Activity above specified. Parent consents to the County of Maui’s use of any photographs, audio or videotapes in informational presentations, newsletters, and media publications or in other County of Maui recreation programs.Parent also understand that the photographs, audio/video recordings are the property of the County of Maui’s DPR.

7. Parent acknowledges and agrees that the Minor shall abide by all rules and regulations of the Activity, or pertaining to the Activity’s location, and all instructions given to the Minor by Event Organizers’ staff, officers, employees, agents and servants. If the Minor fails to follow the instruction, rules or regulations the Minor may barred from further participation in the Activity and Parent will be requested to remove the Minor from the location of the Activity.

8. Parent acknowledges that the Minor is not an employee or independent contractor, and is not entitled to any pay, compensation or benefits for participating in the Activity.

IN WITNESS WHEREOF, the undersigned has executed this Release, Acknowledgment and Indemnification on this October 31, 2024. In signing this form, Parent acknowledges that Parent is at least 18 years of age, and hereby represents that Parent has read the foregoing, understands it, and fully intends to be bound by same.

Date: October 31, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Age Acknowledgment*
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*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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(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 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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
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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