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RELEASE AND INDEMNITY <br />PARENT(S) OR LEGAL GUARDIAN: <br />ON BEHALF <br />OF (MINOR), FOR AN CONSIDERATION OF SAID <br />MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): <br />A <br />That there is substantial value and benefit to be derived by Minor <br />TYPE OF ACTIVITY <br />I FROM (DATE) TO (DATE) <br />in participating in this activity sponsored by the COUNTY. <br />B <br />That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of <br />Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, <br />coach, trainer, or person who is in any manner connected with the operation of the HI -PAL Program, an account of any and all claims, <br />demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's <br />participation in or transportation to and from the subject HI -PAL activity. <br />C <br />That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons <br />other than employees of the COUNTY. <br />D <br />To give consent to allow MINOR to actively participate in ACTIVITY. <br />E <br />That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property <br />damage, commonly inherent in such activity, <br />F <br />That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or <br />LEGAL GUARDIAN, gives approval and consent. <br />G <br />That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. <br />H <br />To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that <br />MINOR cannot safely participate in ACTIVITY. <br />Dated: , 20 , Hawai'i <br />Father Mother Legal Guardian <br />HPD /HIPAL -00113 REVISED 3 -11 -09 RETENTION 3 YEARS <br />