Fishpond Waiver

Each adult (or parent/guardian of a minor child) must submit a waiver, so if you’re part of a group, be sure to sign.

Waivers are available:

to sign online (below)
to print (here) and bring along with you
or at the pond on the day of event

Name(Required)

First Last

Email Address(Required)

Liability Waiver and Release (Each Adult is required to sign their own individual waiver)(Required)

Waikalua Loko I'a is owned and operated by the Pacific American Foundation Hawaii, Inc. and Pacific American Foundation, a 501(c)(3) nonprofit organization (hereinafter PAF, or PAF Released Parties), for educational and charitable activities that benefit the public. The undersigned will be attending one or more educational field site visits, community workdays, or other activities during the year 2021 at Waikalua Loko I`a located at 45-231 Kulauli Street in Kane‛ohe, Oahu.

I, the undersigned, agree I will conduct myself with great regard for our own and others' safety, and I expressly agree to the following:
I. Assumption of Risk, Release and Waiver
PAF Released Parties (Pacific American Foundation Hawaii, Inc., and Pacific American Foundation and their officers, agents, employees or representatives, docents, volunteers and all others acting on their behalf) do not provide liability insurance, or otherwise indemnify against injuries or any other liabilities arising from our participation in these educational and/or recreational activities.

In consideration of being permitted to participate in these educational and/or recreational activities, I/We expressly and voluntarily assume all risk of property damage, personal injury and/or death during, or which may result from, participation in this event.

I/We hereby release, agree to defend, hold harmless, indemnify and discharge PAF Released Parties from any and all liability claims, demands or causes of action that we may have for injuries and/or damages arising out of our participation in the educational field site visit/community workday, including but not limited to, losses caused by the passive or active negligence of ourselves and/or the PAF Released Parties.

I/We further agree that I/we will not sue or make a claim against PAF Released Parties for any damages and/or other losses sustained as a result of our participation in the educational field site visit.

I/We hereby give permission to use photos of me, my group, or my child during the visit to the fishpond. I understand that the intended purpose of the video or photograph will be used solely for educational purposes. I waive any rights of compensation or ownership thereto.

II. For DOE participants only, the following terms apply:

The STATE shall be responsible for the damages or injury caused by the STATE, STATE's agents, officers, and employees, in the course of their employment to the extent that the STATE's liability for such damage or injury has been determined by a court or otherwise agreed to by the STATE, and the STATE shall pay for such damage and injury to the extent permitted by law.

Pacific American Foundation shall be responsible for damages or injury caused by Pacific American Foundation, Pacific American Foundation's agents, officers, and employees
In the course of their employment to the extent that Pacific American Foundation's liability for such damage or injury has been determined by a court or otherwise agreed to by Pacific American Foundation and the Pacific American Foundation shall pay for such damage and injury to the extent permitted by law.

I agree to these terms.

COVID PROTOCOLS(Required)

COVID-19 Protocols for all participants
I understand that participation is totally voluntary and that Pacific American Foundation, its representatives, agents and all others acting on their behalf (hereinafter "PAF Released Parties"), are not responsible or accountable in the unlikely event I / my child/children contract COVID-19 due to participation activities.
I understand and agree that any face to face activity requires a DAILY HEALTH SCREENING. IF I AM FEELING ILL, I WILL NOT COME.

I have been provided/read online the COVID Protocol Document.
I have been provided/read online the PAF COVID protocols online regularly for updates.

I agree to these terms

Hidden

Upload proof of vaccine

We are no longer requiring this, please disregard.

Drop files here or

Accepted file types: jpg, pdf, png, Max. file size: 512 MB.

SIGNATURE SECTION(Required)

I/We have read, understand and agree to LIABILITY WAIVER and RELEASE, and COVID PROTOCOLS and SIGN THIS STATEMENT of my own free will with full knowledge of its contents and meaning.

For minors (under 18 years of age) Parent or Legal Guardian is the PERSON LAWFULLY AUTHORIZED TO SIGN for the minor.

I have had the opportunity to read this entire document. I have read and understood it. I agree to be bound by its terms. I hereby agree and consent to release, relinquish, and forever discharge PAF Released Parties, and PAF's representatives, agents, and all others acting on their behalf, on behalf of myself, my children, my parents, my heirs, assigns, personal representatives and estate from any and all claims, any and all causes of action that I (we) have or may have, whether past, present or future, whether known or unknown, whether anticipated or unanticipated.

I agree to these terms

Signature(Required)

PRINT NAME of SIGNER, and any names of minor children participating in the event(Required)

NAME of SIGNER, plus names of any children under age 18 attending the event, covered by this waiver.

Please enjoy, be safe, practice SOCIAL DISTANCING, and above anything else Malama `Aina a me Malama Kino (take care of the place and yourself). Remember to bring your vaccine card(s) if you did not upload them here.
Mahalo,
Rosalyn KRD Concepcion, Loko I`a Manager

Fishpond Waiver

Share this Online Waiver