Laserfiche WebLink
1 <br />RELEASE OF CLAIMS AND LIABILITY WAIVER <br />This Release of Claims and Liability Waiver is made for Sunday, July 29, 2018 by <br />whose date of birth is / / , (Name of Participant) <br />and whose address is <br />(Street Address/P. O. Box#) (Town/City) (State) (Zip Code) <br />I, the undersigned, either being over the age of eighteen (18) years old, or having the express permission of my parent <br />and/or legal guardian, hereby acknowledge that I have reviewed the Information Sheet for the Annual Richardson <br />Roughwater Swim attached on page 2, which will be held at Richardson Ocean Park on Sunday, July 29, 2018, ("Event") <br />and I am fully aware of the dangers and risks of injury inherent in my participation in this Event. I also acknowledge that I <br />am fully aware of my own physical limitations and I certify that I am physically fit, have sufficiently trained for participation <br />in this Event and have not been advised otherwise by a qualified physician or other health care provider. I will attend the <br />pre -race meeting on the beach prior to the Event which will provide me with the swim course details and instructions and I <br />understand that my failure to attend the pre -race meeting will result in my disqualification from this Event. <br />In consideration of the permission granted to me by the County of Hawaii and the State of Hawaii to participate in this <br />Event, I hereby release the County of Hawaii, the State of Hawai'i, its officers, employees, agents, independent <br />contractors, organizers, race officials, and volunteers of the Annual Richardson Roughwater Swim Event from all actions, <br />causes of action, damages, injuries, claims or demands, which I, my heirs, personal representatives, or assignees may <br />have against the County of Hawaii, the State of Hawai'I, its officers, employees, agents, independent contractors, <br />organizers, race officials, or volunteers for any and all injuries, known or unknown, which I may incur by my participation in <br />the Annual Richardson Roughwater Swim or by my use of the Richardson Ocean Park. <br />I do further agree that I shall indemnify and save harmless the County of Hawaii and the State of Hawai'i, its officers, <br />employees, agents, independent contractors, organizers, race officials, and volunteers, either jointly or severally, from any <br />and all claims, demands, damages, loss of service, or expense for property damage or personal injuries or actions brought <br />by a third party resulting or arising from my participation in the Annual Richardson Roughwater Swim or my use of the <br />Richardson Ocean Park. <br />I, the undersigned, have read this Release of Claims and Liability Waiver and understand all of its terms. I execute it <br />voluntarily and with full knowledge of its significance. This document contains two pages. <br />IN WITNESS WHEREOF, I have executed this Release at <br />Participant's Signature Telephone No. <br />, on this date / / <br />(Place of Execution) <br />Parent/Guardian Waiver for Minors (under 18 years old). The undersigned parent and/or legal guardian does hereby <br />represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of <br />the parties referred to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said <br />parties because of any defect in or lack of such capacity to act and release said parties on behalf of the minor and the <br />parents or legal guardian. (Continued on page 2). <br />If Participant is under 18 years of age: <br />Signature of Parent or Guardian Telephone No. <br />The County of Hawai'i Department of Parks and Recreation provides recreational opportunities without regard to <br />race, color, national origin, age, sex, religion or disability. Please call our Aquatics Office at (808) 961-8694, to discuss <br />your need for reasonable modifications due to disability, or for more information on site accessibility. <br />County of Hawaii is an Equal Opportunity Provider and Employer. <br />