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RELEASE OF CLAIMS <br />This Release of Claims is made on , 20 , by <br />, whose date of birth is <br />(Name of Participant) <br />and whose address is <br />(Street Address/P. 0. Box #) <br />(Town/City) (State) (Zip Code) <br />In consideration of the permission granted to me by the County of Hawaii, State of <br />Hawaii, to participate in <br />(Description of Activity) <br />program at <br />(Name and Address of Facility) <br />(hereafter "Facility") from , 20 , to , 20 <br />(Dates of Activity) <br />I hereby release the County of Hawaii, its agents, independent contractors, and employees from all <br />actions, causes of action, damages, claims or demands, which I, my heirs, personal representatives, or <br />assignees may have against the County of Hawaii, and other above-named parties for all injuries, known <br />or unknown, which may incur by my participation in the above-described activity or by my use of the <br />above-described Facility. <br />I do further agree that I shall indemnify and save harmless the County of Hawaii, or any of its officers <br />or employees, either jointly or severally, from any and all claims, demands, damages, loss of service, or <br />expense for property damage and for personal injuries or actions brought by a third party resulting or <br />arising from my participation in the above-described activity or my use of the Facility. <br />I, the undersigned, have read this Release and understand all of its terms. I execute it voluntarily <br />and with full knowledge of its significance. <br />IN WITNESS WHEREOF, I have executed this Release at <br />on the day and year first written above. (Place of Execution) <br />Printed Name of Witness (age 18 or older) <br />(All signatures require a witness) <br />Participant's Signature Telephone No. <br />If Participant is under 18 years of age: <br />Signature of Parent or Guardian Telephone No. <br />Witness's Signature Telephone No. <br />(All signatures require a witness signature) <br />5/23/06 <br />