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Release and Waiver of Liability Agreement

November 4, 2025

The non-profit organization, Ke Kahua O Kuali'i, has my permission to use my or my child's photograph publically to pormote the organization. I understand that the images may be used in print publication, online publication, 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 have requested the Department of Land and Natural Resources to allow me or my child to engage in the following activity or activities on State of Hawai’i property known as the Ke Kahua O Kūaliʻi and I. (the "Participant"), acknowledge that I have voluntarily applied to participate in the Ke Kahua O Kuali'i project (the "Project"), which Project will involve the cutting, clearing, and eradication of non-invasive plants, industrial debris, restoration and re-vegetation in and adjacent to the Kawainui pond—activities working outside that include being in the sun, wind, and/or rain, in water and/or on land.

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, POISONING, AND PROPERTY DAMAGE, WHETHER THESE RISKS ARE KNOWN OR UNKNOWN.

  • gusty winds
  • sharp and / or slippery rocks
  • Stinging or biting insects and spiders
  • portable or no bathroom facilities
  • no potable drinking water
  • steep drop-offs
  • rugged terrain
  • sharp tools
  • lack of nearby medical facilities
  • steep and slippery trail and river crossings
  • harsh weather conditions (ranging from hot and humid to wet and cold)
  • dense, tangle vegetation
  • thorny plants
  • work on or near steam and ocean water
  • wet or slippery roads
  • herbicides
  • paint, fuel, and oil fumes
  • work in hunting area
  • wild animals
  • flash floods
  • lack of reliable communication service (including no telephone service)
  • diseases caused by water, air, or animal vectors

I verify this statement by placing my initials here


Knowing that the above-described activity or activities at the Park may present certain risks and dangers to me or my child, including A RISK OF SERIOUS BODILY HARM OR DEATH, I nevertheless permit myself or my child to engage in the above-described activity or activities at the Park. I voluntarily ASSUME THE RISK OF INJURY OR LOSS created by the above-described conditions, hazards, and dangers at the Park.

With full knowledge of said conditions, hazards, and dangers, I RELEASE AND AGREE TO INDEMNIFY AND HOLD HARMLESS  Ke Kahua O Kualii and the State of Hawaii, and any and all of its officers, employees, and agents, for death or injury to me or my child or damage to or destruction of any of my or my child’s property resulting from the conditions, hazards, and dangers listed above.

In consideration for allowing me or my child to engage in the above-described activity or activities at the Park which I have requested, I, for my heirs, beneficiaries, executors, and administrators, REMISE, RELEASE, AND FOREVER DISCHARGE Ke Kahua O Kuali’i and the State of Hawaii, and any and all of its officers, employees, and agents, acting in their official capacities, from any and all claim(s), demand(s), or cause(s) of action on account of my or my child’s death or personal injury or on account of any injury to my or my child’s property which may occur from my or my child’s negligence, hazards listed herein, or an unforeseeable event, during my or my child’s activity or activities at the Park described above.

The undersigned Participant should not enter the water or marsh 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.


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First Participant - Name
First Name*
Last Name*
Phone*
Select Gender
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participant - Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
First Participant's Signature*
Second Participant - Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Second Participant - Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
Third Participant - Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Third Participant - Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
Fourth Participant - Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Fourth Participant - Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
Fifth Participant - Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Fifth Participant - Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
Sixth Participant - Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Sixth Participant - Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
Seventh Participant - Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Seventh Participant - Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
Eighth Participant - Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Eighth Participant - Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
Ninth Participant - Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Ninth Participant - Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
Tenth Participant - Name
First Name*
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Tenth Participant - Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
Parent or Guardian's Email Address
Email*
Confirm Email*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
Participant - 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*
Last Name*
Relationship*
Phone*
Select Gender
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Adult
Date Visiting:
Name of School or Group, if applicable: *
Name of Teacher or Coordinator, if applicable: *
Ethnicity **some grants require this information**
Pacific Islander
Native American or Native Alaskan
Native Hawaiian
Asian
Black or African American
Caucasian
Hispanic or Latino
Other
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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