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2023 RICHARDSON ROUGHWATER SWIM ENTRY
<br />PLEASE PRINT: MALE FEMALE
<br />(Last Name) (First Name)
<br />ADDRESS:
<br />DATE OF BIRTH
<br />(Street / P.O. Box) (City) (State) (Zip)
<br />AGE on race day: T-SHIRT SIZE: S M L XL XXL
<br />Please indicate which event you are entering (circle one): FINLESS FINS
<br />RELEASE OF CLAIMS
<br />This Release of Claims is made for Sunday, October 22, 2023 by , whose date of birth
<br />and whose address is
<br />(Name of Participant)
<br />(Street Address/P. O. Box #) (Town/City) (State) (Zip Code)
<br />In consideration of the permission granted to me by the County of Hawai'i, State of Hawai'i, to participate in the Annual
<br />Richardson Roughwater Swim at Richardson Ocean Park, on Sunday, October 22, 2023, I hereby release the County of
<br />Hawai'i, the State of Hawai'i, Department of Land and Natural Resources, and Division of Boating and Ocean Recreation,
<br />its agents, independent contractors, and employees, as well as all organizers, race officials, and volunteers of the Annual
<br />Richardson Roughwater Swim from all actions, causes of action, damages, injuries, claims or demands, which I, my heirs,
<br />personal representatives, or assignees may have against the County of Hawai'i, the State of Hawai'i, or the volunteers
<br />and race officials, and other above -named parties for all injuries, known or unknown, which I may incur by my participation
<br />in 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 Hawai'i and State of Hawai'i, or any of its officers
<br />or employees, eitherjointly or severally, from any and all claims, demands, damages, loss of service, or expense for property
<br />damage and for personal injuries or actions brought by a third party resulting or arising from my participation in the Annual
<br />Richardson Roughwater Swim or my use of the Richardson Ocean Park. I further agree to indemnify and save harmless the
<br />Annual Richardson Roughwater Swim organizers, race officials, and volunteers, jointly and severally, from any and all
<br />claims, demands, damages, loss of service or expense for property damage and personal injuries or actions brought by a
<br />third party resulting or arising from my participation in the Annual Richardson Roughwater Swim at Richardson Ocean Park.
<br />I, the undersigned, have read this Release and understand all of its terms. I execute it voluntarily and with full knowledge
<br />of its significance.
<br />IN WITNESS WHEREOF, I have executed this Release at , on this date
<br />(Place of Execution)
<br />Participant's Signature Telephone No.
<br />If Participant is under 18 years of age:
<br />Signature of Parent or Guardian Telephone No.
<br />Printed Name of Witness (age 18 or older) Witness's Signature Telephone No.
<br />(All signatures require a witness signature)
<br />Notice: All participants must be in good health and able to swim an open water mile. Just prior to the start, a pre -race meeting
<br />will be held on the beach giving course details and instructions. All participants are expected to attend this meeting.
<br />The County of Hawai'i Department of Parks and Recreation provides recreational opportunities without regard to race, color, national
<br />origin, age, sex, religion or disability. Please call (808) 961-8681, to discuss your need for reasonable modifications due to disability, or
<br />for more information on site accessibility. County of Hawai'i is an Equal Opportunity Provider and Employer.
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