2018 Roughwater Swim - Richardson Ocean Park, Sunday, July 29, 2018

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