HomeMy WebLinkAbout2019 Youth Football Clinic & Release of Claims Form (June 11, 2019, Old Kona Airport Field)COUNTY OF HAWAII
DEPARTMENT OF PARIS AND RECREATION
In association with
IV RMEW
2019 Youth Football Clinic
Old Kona Airport Fold
75-5560 Kucikiril Hiyhwaj, Kailua, Hl 067i0
Tuesddq lune 11.2019
8=00om checkin Doom-1:00pm Clinic
Al[ oth[ekhes 7 ifs old - YE qrs old
RELEASE OF CLAIMS
This Release of Claims is made on , 20 , by
, whose date of birth is
(Name of Participant)
and whose address is
(Street Address/P. 0. Box #)
(Town/City) (State) (Zip Code)
In consideration of the permission granted to me by the County of Hawaii, State of
Hawaii, to participate in
(Description of Activity)
program at
(Name and Address of Facility)
(hereafter "Facility") from , 20 , to , 20
(Dates of Activity)
I hereby release the County of Hawaii, its agents, independent contractors, and employees from all
actions, causes of action, damages, claims or demands, which I, my heirs, personal representatives, or
assignees may have against the County of Hawaii, and other above-named parties for all injuries, known
or unknown, which may incur by my participation in the above-described activity or by my use of the
above-described Facility.
I do further agree that I shall indemnify and save harmless the County of Hawaii, or any of its officers
or employees, either jointly or severally, from any and all claims, demands, damages, loss of service, or
expense for property damage and for personal injuries or actions brought by a third party resulting or
arising from my participation in the above-described activity or my use of the Facility.
I, the undersigned, have read this Release and understand all of its terms. I execute it voluntarily
and with full knowledge of its significance.
IN WITNESS WHEREOF, I have executed this Release at
on the day and year first written above. (Place of Execution)
Printed Name of Witness (age 18 or older)
(All signatures require a witness)
Participant's Signature Telephone No.
If Participant is under 18 years of age:
Signature of Parent or Guardian Telephone No.
Witness's Signature Telephone No.
(All signatures require a witness signature)
5/23/06