Release of Claims Form 1.15.26 ADA (locked)

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Department of Parks and Recreation *' RELEASE OF CLAIMS h l` 'Fk1P This RELEASE OF CLAIMS is made inconsideration of the permission granted tome and/or the minor(s) under my parental authority or legal guardianship by the County of Hawaii, State of Hawaii either directly or through a third party to participate in: [Name of Event, Activity or Program] from throu [Month & Year] [Month & Year] (hereinafter "subject activity(ies)") to be held, performed and/or conducted at the following facility(ies): I understand and acknowledge the nature of the subject activity(ies) and I represent that I am in appropriate physical, mental, and emotional health and able to participate safely. If, at any time, I believe the conditions of my participation to be unsafe, I will immediately cease further participation. I acknowledge and agree that any injury or medical condition that I may sustain or suffer and any injury or medical condition I may cause in connection with my participation will not be covered by any insurance policies held or obtained by the County of Hawaii and the County of Hawaii will not be responsible for or required to indemnify or defend me with respect to any illness, personal or bodily injury, death, economic and property damage, severe emotional loss, and any other loss, damage, or injury (collectively the "Injuries/Damages") that I may sustain or suffer in connection with my participation in the subject activity(ies) and/or by my use of the stated facility(ies). I understand and acknowledge the dangers and risks involved in my participation in the subject activity(ies) and/or by my use of the stated facility(ies) including the Injuries/Damages. These Injuries/Damages may be caused by actions or inactions of myself or others participating in the subject activity(ies) and/or the conditions at the stated facility(ies). I acknowledge that there may be other Injuries/Damages not known to me or not readily foreseeable at this time. I fully accept and assume all risks of the Injuries/Damages resulting from my participation. I have read and understood all written materials setting forth the requirements for my participation and I will observe, follow, and comply with all verbal and written instructions. I hereby agree and declare for myself, my heirs, executors, administrators, successors and assigns, to fully release, remise, and forever discharge the County of Hawaii and its members, agents, and employees, from any and all manner of actions, causes of action, suits, debts, judgments, executions, claims and demands whatsoever, known or unknown, in law or equity, which I ever had, now have, may have, or claim to have against any or all of said entities or individuals arising out of or by my participation in the subject activity(ies) and/or by my use of the stated facility(ies). I have read this release and understand all its terms. I execute it voluntarily, and with full knowledge of its significance. Name: [LAST] Signature: [FIRST] Date: IM.l.] ❑ Adult Minor ❑ if the participant its a_minor, _parent or iogaL gUairdiian shaii_piroviido_add iitiionai information as folios: Name: [LAST] Signature: Page 1 of 2 [FIRST] Date: fM l ] Parent Legal Guardian Return completed form to the facility staff 01/2026