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HomeMy WebLinkAbout2012 Winter Basketball Classic Registration PacketWilliam P. Kenoi Mayor OF Mp� CDuntp Of'abiai" i DEPARTMENT OF PARKS AND RECREATION 101 Pauahi Street, Suite 6 • Hilo, Hawaii 96720 (808) 961 -8311 • Fax (808) 961 -8411 PRESS RELEASE November 16, 2012 FOR IMMEDIATE RELEASE Robert A. Fitzgerald Director Clayton S. Honma Deputy Director Youth Teams Invited to Enter HI -PAL Winter Basketball Classic Youth basketball teams from throughout the state will gather Dec. 26 -29 in Hilo to compete in the 32 "a Annual HI -PAL Winter Basketball Classic. Sponsored by the Hawaii County Department of Parks and Recreation and the Hawaii Isle Police Activities League or HI -PAL, this popular tournament is open to boys and girls ages 5 to 14 years old. Last year's highly successful tournament attracted more than 500 keiki athletes from 52 different teams. This year's games will be played at various East Hawaii gymnasiums. A dinner banquet for all participating teams and a special skills challenge will be part of the four -day tournament. Teams have until December 14 to register. The fee is $80 per team, with a discounted $60 price for each team entering the 8- year -old and under category. Tournament scheduling will give teams, coaches and parents opportunities to visit some of East Hawai`i's world -class attractions. The `Imiloa Astronomy Center of Hawai`i's full -dome planetarium, Hilo's black -sand beaches, majestic Rainbow Falls, and the free Pana'ewa Rainforest Zoo and Gardens are all located within a short drive from the tournament venues. For those wishing to venture a little further, Hawaii Volcanoes National Park includes Kilauea Volcano, which has been erupting continuously since 1983. For more information or to register, please call HI -PAL's Joey Botelho Jr. at 961 -2220 or 961- 8121. Inquiries may also be made to Darrell Yamamoto, P &R recreation specialist, at 961 -8740, ext. 25, or Jason Armstrong, P &R Public Information Officer, at 345 -9105, or jannstrong@co.hawaii.hi.us. -30- County of Hawaii is an Equal Opportunity Provider and Employer. HI -PAL WINTER BASKETBALL CLASSIC DECEMBER 26 -29, 2012 HILO, HAWAII RULES AND REGULATIONS PLEASE READ AND BE GUIDED BY 1. RULES & REGULATIONS: A. The HHSAA Book of Rules and HI -PAL Amended Rules will govern Tounrmament Play. B. HI -PAL RULES: 1. Coaches will be limited to the area immediately fronting the team bench and from one end of the bench to the other end during the game. ONLY ONE (1) COACH MAY STAND DURING THE GAME. 2. THIS IS A DRUG FREE ACTIVITY! No smoking and no drinking of alcohol beverages during this activity, (coaches, players and supporters). Anyone who smells of these activities will not be allowed to participate that day /night. 3. ELIGIBILITY AFFIDAVIT (ROSTER) - Must be submitted to the HI -PAL office by December 14, 2012. Eligibility affidavits can be mailed to: HI -PAL WBBC 2012 C/O Hawaii County Police Department 349 Kapiolani Street Hilo, HI 96720 Or you may fax it to (808) 961 -2209. This will confirm your team's entry into the tournament. NO ELIGIBILITY AFFIDAVIT, NO PLAY! The addational forms (Waiver, Coaches Code of Conduct, Athletes Code of Conduct and Guidelines for Supporters) must also be completed and turned in to HI -PAL in a timely manner. HI -PAL WINTER BASKETBALL CLASSIC PAGE 2 4. PARTICIPATION: A player who is participating on a High School Junior Varsity or Varsity team is INELIGIBLE to participate in this tournament. (Participation means that they are listed officially on the school's roster for the current season.) A player may play IN TWO divisions for this classic, (if there is a shortage of player participation in the other age division). AGE CUT OFF DATE: DECEMBER 31, 2012 5. TIME -OUTS: Teams will be allowed two (2) time -outs per half. No carry over, and one (1) per overtime. 6. GAME LENGTHS: Games will be played in two (2) halves, with a three (3) minute halftime, and five (5) minutes between games. Teams should be at their respective gyms 30 minutes before your scheduled game time. Games may start before your scheduled game time. There will be NO grace period. Please be prompt! 5 -6 & 7 -8 Divisions: 8 minute halves, one minute overtime 9 -10 Division: 8 minute halves, one- minute overtime Girls 12 & Under: 9 minute halves, one - minute overtime 11 -12 Division: 10 minute halves, two- minutes overtime Girls 14 & Under: 10 minute halves, two- minutes overtime 13 & 14 Division: 11 minute halves, two- minutes overtime 7. UNIFORMS: All players must wear rubber soled shoes, shirts or tank tops, identical in color, (identifiying their respective teams), and gym shorts. Team shirts must be numbers on the back. Numbers on the front are optional. No trousers and belt will be allowed, including sweatpants. Teams that have same colored uniforms may be required to wear a numbered vest. A coin flip will determine which team uses the vest. 8. PARTICIPATION: No Participation rule. HI -PAL WINTER BASKETBALL CLASSIC PAGE 3 9. PARENTS & SUPPORTERS: Please refrain from making derogatory remarks to other PLA YERS, COACHES AND OFFICIALLS. Any unsportsmanlike conduct will result in a technical foul on responsible team s coach and possible removal from facility for that game and /or tournament. COACHES: You will not be allowed to approach or question scorekeeper or timers except• during a time -out or at half time. No one else is allowed to question the timer or scorer. If you have a question, call a time -out and alert the officials of the game and if there is a change, you will be given back your time -out. Penalty will be a technical foul! Team statisticians may check with the official scorer only during half time. OFFICIAL SCOREBOOK WILL PREVAIL! 10. ADVANCEMENT: Teams will advance in pool and bracket play via: 1. Won -Loss. 2. Head to Head. 3. Points Scored. 4 Points given up. REMEMBER, THIS ACTIVITY IS FOR OUR YOUTH AND THAT WE, AS ADULTS, SHOULD LET THEM PLAY THE GAME. AT RISK: YES NO HAWAII POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION I PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI ❑ YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES ❑ NO FOSTER CARET ❑ YES ❑ NO COURT REFERALI []YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N.KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHORTJ CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPD /HIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. I B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity, C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and/or property damage, commonly inherent in such activity, F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawai'i Father Mother Legal Guardian HPDIHIPAL -0018 REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAI'I POLICE DEPARTMENT HAWAI'i ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION I PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ , CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI []YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES ❑ NO FOSTER CARE? ❑ YES ❑ NO COURT REFERAL? ❑ YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ , PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE I CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPD /HIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY I FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity, F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawai'i Father Mother Legal Guardian HPD /HIPAL -00113 REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAI'I POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION I PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI []YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES ❑ NO FOSTER CARE? ❑ YES [:1 NO COURT REFERALI ❑YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION PHYSICAL HANDICAP, IF ANY: I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no familv Phvsician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: 7POLICY NUMBER EXPIRATION DATE HPD1HIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity, F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawai'i Father Mother Legal Guardian HPD /HIPAL -00113 REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAII POLICE DEPARTMENT HAWAI'l ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION I PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI ❑ YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? []YES ❑ NO FOSTER CARE? ❑ YES ❑ NO COURT REFERAL? ❑ YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N.KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family Physician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE I CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPDIHIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and/or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity. F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: .20 , Hawai'i Father Mother Legal Guardian HPD /HIPAL -00113 REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAI'I POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI ❑ YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES ❑ NO FOSTER CARE? ❑ YES ❑ NO COURT REFERAL? ❑YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N.KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION PHYSICAL HANDICAP, IF ANY: I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the a enc . IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE I CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPD /HIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE (S): A That there is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity. F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawail Father Mother Legal Guardian HPD /HIPAL -001 B REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAI'1 POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION I PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE 'LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI ❑ YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES ❑ NO FOSTER CARET (I YES ❑ NO COURT REFERAL7 ❑YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION PHYSICAL HANDICAP, IF ANY: give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE I CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPD 1HIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREES : A That there is substantial value and benefit to be derived by Minor I TYPE OF ACTIVITY FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity, F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is In reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawaii Father Mother Legal Guardian HPD /HIPAL -00113 REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAII POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI ❑ YES []NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES ❑ NO FOSTER CARE? [I YES [I NO COURT REFERAL? [I YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION PHYSICAL HANDICAP, IF I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPD /HIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE S): A That there is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY I FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and/or property damage, commonly inherent in such activity, F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health such that the MINOR can safely participate in ACTIVITY. H notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that ITo MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawaii Father Mother Legal Guardian HPD /HIPAL -001 B REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAII POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI []YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? []YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES ❑ NO FOSTER CARE? ❑ YES ❑ NO COURT REFERAL? ❑YES []NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is nc family physician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPD /HIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity. F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawaii Father Mother Legal Guardian HPD /HIPAL -001 B REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAII POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI ❑ YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? []YES ❑ NO FOSTER CARET El YES ❑ NO COURT REFERAL? ❑YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA • ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION PHYSICAL HANDICAP, IF ANY: I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE I CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPDIHIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there Is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity, C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity, F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: .20 , HawaH Father Mother Legal Guardian HPD /HIPAL -001B REVISED 3 -11 -09 RETENTION 3YEARS AT RISK: YES NO HAWAII POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSQ YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES []NO FOSTER CARE? ❑ YES ❑ NO COURT REFERAL? ❑ YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N.KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is-no family physician available, the discretion for the selection of a doctor will be left to the agency. _ IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPDIHIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity, C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity, F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that ITo MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawai'i Father Mother Legal Guardian HPD /HIPAL -00113 REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAI'I POLICE DEPARTMENT HAWAI'l ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI ❑ YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? []YES ❑ NO FOSTER CARET ❑ YES ❑ NO COURT REFERAL? ❑YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION PHYSICAL HANDICAP, IF ANY: I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the aciencv. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE I CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER —[-EX— PIRATION DATE HPD /HIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there is substantial value and benefit to be derived by Minor I TYPE OF ACTIVITY I FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and/or property damage, commonly Inherent in such activity, F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that ITo MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawail Father Mother Legal Guardian HPD /HIPAL -001 B REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAII POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION TEAM NAME AGED ISION PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI []YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? } []YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES ❑ NO FOSTER CARE? ❑ YES ❑ NO COURT REFERAL? El YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION PHYSICAL HANDICAP, IF ANY: I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the agencv. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPD /HIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity. F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: , 20 . Hawai i Father Mother Legal Guardian HPD /HIPAL -001 B REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAI'I POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI ❑ YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES ❑ NO FOSTER CARE? ❑ YES ❑ NO COURT REFERAL? ❑ YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION PHYSICAL HANDICAP, IF I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE I CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPDIHIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there is substantial value and benefit to be derived by Minor I TYPE OF ACTIVITY I FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity, F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate In ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawai i Father Mother' Legal Guardian HPD /HIPAL -001 B REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAI'1 POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION PERSONAL INFORMATION NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI ❑ YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? []YES ❑ NO FOSTER CARE? []YES ❑ NO COURT REFERAL? ❑ YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANMEWA MEDICAL INFORMATION I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPDIHIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there Is substantial value and benefit to be derived by Minor TYPE OF ACTIVITY FROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity. C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and/or property damage, commonly inherent in such activity. F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H notify a representative from the HI -PAL Program if there Is any change in MINOR's physical and /or mental condition such that ITo MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawail Father Mother Legal Guardian HPD /HIPAL -001B REVISED 3 -11 -09 RETENTION 3 YEARS AT RISK: YES NO HAWAII POLICE DEPARTMENT HAWAII ISLE POLICE ACTIVITIES LEAGUE PLEASE PRINT AND COMPLETE ALL INFORMATION I TEAM NAME AGE DIVISION 17�:��e7►/T>11110NUS TiTiM -- Uoni NAME OF PARTICIPANT (Last, First, Middle Initial) N. HILO ❑ AGE BIRTH DATE RES. PHONE MAILING ADDRESS S. KONA ❑ CITY STATE ZIP CODE SCHOOL KEAUKAHA ❑ HAMAKUA ❑ GRADE FATHER'S NAME PUNA ❑ RES. PHONE BUS. PHONE CELL MAILING ADDRESS HAKALAU ❑ CITY STATE ZIP CODE MOTHER'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE LEGAL GUARDIAN'S NAME RES. PHONE BUS. PHONE CELL MAILING ADDRESS CITY STATE ZIP CODE ARE YOU CURRENTLY RECEIVING GOVERNMENT SUBSIDY? EXAMPLE: DSS, SOCIAL SECURITY, SSI []YES ❑ NO ARE YOU CURRENTLY RESIDING IN GOVERNMENT HOUSING? ❑ YES ❑ NO ARE YOU A SINGLE PARENT FAMILY? ❑ YES ❑ NO FOSTER CARE? [:1 YES ❑ NO COURT REFERALI [:1 YES ❑ NO GEOGRAPHICAL LOCATION ❑ N. HILO ❑ S. KOHALA ❑ KA'U ❑ S. KONA ❑ PAPAIKOU ❑ HONOMU ❑ KEAUKAHA ❑ HAMAKUA ❑ N. KOHALA ❑ PUNA ❑ WAINAKU ❑ PEPEEKEO ❑ HAKALAU ❑ PANA'EWA MEDICAL INFORMATION PHYSICAL HANDICAP, IF ANY: I give my consent for your Agency to refer my child, if injured or ill, to my family physician when I cannot be reached. Where there is no family physician available, the discretion for the selection of a doctor will be left to the agency. IN CASE OF EMERGENCY, CONTACT RES. PHONE BUS. PHONE CELL PHYSICIAN'S NAME OFFICE PHONE NUMBER MEDICAL INSURANCE COVERAGE: POLICY NUMBER EXPIRATION DATE HPDIHIPAL -001A REVISED 3 -11 -09 RETENTION 3 YEARS RELEASE AND INDEMNITY PARENT(S) OR LEGAL GUARDIAN: ON BEHALF OF (MINOR), FOR AN CONSIDERATION OF SAID MINOR BEING PERMITTED TO PARTICIPATE IN THE HI -PAL SPONSORED ACTIVITIES, HEREBY EXPRESSLY AGREE(S): A That there is substantial value and benefit to be derived by Minor I TYPE OF ACTIVITY 7ROM (DATE) TO (DATE) in participating in this activity sponsored by the COUNTY. B That they shall forever release and waive all rights to bring suit or claims against and will indemnify and hold harmless, the County of Hawaii, it's officers, agents and employees, HI -PAL Program, the Hawaii Police Department, or any representative, sponsor, manager, 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, demands, loss of services, or expense for property damage, and /or personal injuries, that may arise as a result of said minor's participation in or transportation to and from the subject HI -PAL activity, C That COUNTY is not to be held liable for death or injuries resulting during period when MINOR Is transported to ACTIVITY by persons other than employees of the COUNTY. D To give consent to allow MINOR to actively participate in ACTIVITY. E That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk of death, personal injury, and /or property damage, commonly inherent in such activity, F That MINOR, through PARENT, or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G That said MINOR is in reasonable good physical and mental health, such that the MINOR can safely participate in ACTIVITY. H To notify a representative from the HI -PAL Program if there is any change in MINOR's physical and /or mental condition such that MINOR cannot safely participate in ACTIVITY. Dated: , 20 , Hawai'i Father Mother Legal Guardian HPD /HIPAL -001 B REVISED 3 -11 -09 RETENTION 3 YEARS `ACTIVITIES J CLUB: HAWAI'I POLICE DEPARTMENT 349 KAPI'OLANI STREET HILO, HAWAII 96720 HI -PAL TEAM Fl IGIRII ITY PO.gTFR EAST HAWAI' I PHONE FAX (808)961-2220 808 961 -2209 WEST HAWAII 808 326 -4646 EX 258 808 327 -3653 PARTICIPANT I BIRTHDATE I UNIFORM # I W I BC T -SHIRT SIZE I CERTIFY THAT THE DATES OF BIRTH OF THE PARTICIPANTS LISTED ABOVE ARE CORRECT AND HAVE BEEN SUBSTANTIATED BY BIRTH CERTIFICATES EXAMINED BY ME. THAT THE ADDRESSES OF EACH PARTICIPANT IS CORRECT AND EACH PARTICIPANT LIVES WITHIN THE BOUNDARIES. SIGNATURE AUTHORIZED CLUB OFFICIAL DATE TIME PHONE NO. SIGNATURE HI -PAL DIRECTOR HPD /HIPAL -009 REV 3 -11 -09 RETENTION HAWAI-I ISLAND POLICE ACTIVITIES LEAGUE COACHES CODE OF ETHICS The coach(es) should first realize that as a coach, he or she is in a responsible position as a teacher of attitudes and ideals of good sportsmanship and fair play, which are basic elements of good citizenship. A coach(es) should remember that he or she teaches as much by example and deeds as by what he or she `PREACHES ". Hence, a coach should strive in every way to be the type of a person who by his or her daily conduct will help to mold good character in the boys and girls who participate. THE COACHES(ES) shall: 1. Strive for excellence. 2. Eliminate as much as possible the practice which tend to destroy the worthwhile values of the sport. 3. Pay close attention to the physical conditioning and well -being of his or her players, refusing to jeopardize the health of an individual for the sake of improving his or her team's chances to win. 4. Respect officials and their decisions. Arguments with officials should only be held in unemotional situations, never publicly and only privately with constructive intent. 5. Emphasize and practice the attitudes and values of god sportsmanship, upright conduct, spirit of fair play, respect for authority, self - control, self- direction, and sound judgment. 6. Be RESPONSIBLE for the athletes safety, on any activity with the HI -PAL program. Also, on traveling trips. 7. The HI -PAL program will not accept VERBAL ABUSE. Complaints will be investigated and a decision will follow. 8. SMOKING will not be allowed on or within the immediate area of a playing field or court while HI -PAL activities are in progress. 9. CONSUMPTION OR USE OF ALCOHOLIC, ILLEGAL OR DANGEROUS DRUGS OR NARCOTICS IS PROHIBITED!!!!! ANYONE FOUND TO BE UNDER THE INFLUENCE, INTOXICATED OR IN POSSESSION OF ANY OF THESE, WILL BE AUTOMATICALLY TERMINATED FROM HI -PAL PARTICIPATION!!!!!!!! 10. Coaches, as "ROLE MODELS" are expected to be Law - abiding citizens and as such are subject to disciplinary action by HI -PAL Program. 11. It is understood and agreed that the HI -PAL Program may reject and coach - volunteer based on information derived there from. DISCIPLINARY ACTION 1. MISDEMEANOR OFFENSES —Possible suspension and or termination as a coach with the HI -PAL Program. 2. FELONY OFFENSES — Termination from the Program as a coach. * *HI -PAL STAFF WILL INVESTIGATE ALLEGED OFFENSES AND BASE THEIR DECISION ACCORDING TO INFORMATION PROVIDED BY POLICE INVESTIGATOR AND WITNESS. APPEAL PROCESS Coach or his representative must submit in WRITING to the HI -PAL PROGRAM: 1. Circumstances of the incident. A list of witnesses on his /her behalf, along with their addresses or telephone numbers. 2. Corrective action taken. preventive measures to insure that there are no further violations. I FULLY UNDERSTAND MY RESPONSIBILITIES AND DUTIES AS A COACH FOR THE HI -PAL PROGRAM. 1 WILL ABIDE BY THE GUIDELINES SET FORTH. TEAM NAME DATE HEAD COACH (PRINT NAME) SIGNATURE DATE ASSISTANT COACH(ES) PRINT NAME SIGNATURE PRINT NAME SIGNATURE PRINT NAME SIGNATURE ACTIVITY: ❑BASKETBALL ❑BASEBALL ❑VOLLEYBALL ❑TENNIS ❑OTHER HPDIHIPAL -007 REV 3 -11 -09 RETENTION: 2 YEARS HAWAI'l ISLAND POLICE ACTIVITIES LEAGUE ATHLETES CODE OF ETHICS THE ATHLETE shall: 1. Show RESPECT and SPORTSMANSHIP to the officials, opponents; HI -PAL, staff and spectators. 2. Accept victory modestly, defeat gracefully, and never quit. 3. Control emotions at all times and never argue with officials or fight with your opponents at anytime. 4. Accept decisions as they are made and abide by them. 5. _ Never SWEAR, CHEAT, or "TAUNTING" to your opponents, officials and fans. 6. Use his or her influence on and off the court/field to help develop good spectator sportsmanship. 7. ALWAYS REMEMBER, THAT YOU ARE REPRESENTING THE HI -PAL PROGRAM. I fully understand my responsibilities and duties as an ATHLETE playing within HI -PAL PROGRAM. I will abide by the guidelines set forth. ATHLETE'S SIGNATURE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. I have read the "Athletes Code of Ethics" to my players. COACH'S SIGNATURE 75ATE DISCIPLINARY ACTION 1. Behavior at home or in school. Counseling or Suspension. Action by Parents or Coaches, Discretion. 2. Behavior and or attitude at practices or games. Counseling or Suspension. Action by Parents, Coaches or HI -PAL staff. Discretion. 3. Status Offenses - (Runaway or Curfew). Counseling, Suspension or termination of season. Action by Parents, Coaches or HI -PAL Staff. Athlete may appeal. 4. Criminal Offenses - (Violation - Misdemeanor). Counseling, Suspension or termination of season. Action by Parents, Coaches or HI -PAL Staff. May Appeal. S. Criminal Offense - (Multiple offenses or Felonies). Suspension- termination of season. Action. by Hl -PAL Staff. May Appeal. APPEAL PROSESS Athlete or representative must submit in WRITING to HI -PAL Program: 1. Circumstances of incident. A list of witnesses on his behalf along with their addresses or telephone numbers. 2. Any corrective action taken and preventive measures. Final decision will be made by HI -PAL Director and Supervisor. Termination would be for the season. May apply for reinstatement the following year. HPDHIPAL -006 REV 3 -11 -09 RETENTION HAWAI'I ISLE POLICE ACTIVITIES LEAGUE GUIDELINE FOR TEAM PARENTS OR GUARDIANS 1. Teach the ideals of good sportsmanship and fair play by setting an example for your child and other athletes. Your demeanor at practices and scheduled games is a big factor to achieve these details. 2. Controversies will arise, and tough decisions must be made. The HI -PAL staff, HI -PAL Supervisor, Head Coach and his staff will make those decisions in the best interest of the child and the Program. Keep in mind that HI -PAL exists solely for our youth. 3. No interference with the coaching staff during practices and scheduled games. Any coaching or personal corrections should be done on your own time. 4. Any questions or doubts, should be brought up to the attention of the Head Coach. Should the problem remain unsolved, a parent meeting will be scheduled, which will include the Head Coach and his/her coaching staff and the HI -PAL staffing charge. 5. Always contribute-in a- positive manner to the smooth operation of the HI -PAL program by wholehearted cooperation and interest. 6. In cheering for your team, positively encourage the players, refrain from negative comments. Reports of negative cheering, criticism of opposing players or coaches, intimidation of officials and opposing team supporters will be investigated and may jeopardize your team's association with the HI -PAL Program. The following people have read or had read to them the parents guidelines and agree to the best of their abilities to follow the guidelines and encourage family and friends to do the same. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. i nave reaa ine -- rarents uoae or ttnics• to my parents. Coach's Signature Date HPDIHIPAL -008 REV 3 -11 -09 RETENTION