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fishpond-waiver
webmaster
2025-04-18T10:29:51-10:00
Legal Name of Adult Participant
(Required)
Each adult completes and signs a form please.
First
Last
Email address
(Required)
Event Type
(Required)
Ka Loli Event August 2
La Ohana Day Sept 20
School/Field Trip/Private Group
Other
Date of Visit
(Required)
MM slash DD slash YYYY
Are you bringing children (anyone under 18)?
(Required)
If you are the legal guardian/parent, you can sign for the child/children. If you're a teacher or group leader, please ask all the parents to come to https://thepaf.org/fishpondwaiver to sign for their child. Or print out and send home to parents with any group or school permission slips.
Please enter a number from
0
to
30
.
Are any of the children Malama or Lokahi afterschool students?
No
Yes! Mālama
Yes! Lōkahi
Names (under 18yrs old)
(Required)
Anything special we need to know?
Agreement
(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 for educational and charitable activities that benefit the public,
hereinafter "PAF Ohana".
I, (or my children), will participate in one or more community workday or other activities this year, including this event specified, at Waikalua Loko I`a located at 45-231 Kulauli Street in Kane‛ohe, Oahu, (hereinafter "Event").
On all occasions, I agree to conduct myself with great regard for my own and others' safety.
Assumption of Risk
"
PAF Ohana"
does not provide liability insurance, or otherwise indemnify against injuries or any other liabilities arising from our participation in the Event. I assume all risk.
Media Permission:
I authorize PAF Ohana to take and use photographs, video, and sound recordings of and/ or live stream my/my child’s participation , and to use our name, image, likeness, appearance, and voice (collectively the “Recordings”) for any legitimate purpose, including any educational, institutional, scientific, fundraising or informational purposes whatsoever, in perpetuity, on a worldwide basis, without compensation to my child or me, in any manner or media, including use on social media sites and web pages accessible to the general public, alone or in combination with other Recordings.
All rights, title, and interest in the Recordings belong solely to PAF Ohana. I consent to my child’s inclusion in media coverage which may appear in print media, live or replay telecast or broadcast, podcast, and/or through social media and internet postings. The use of unmanned aerial systems (UAS) may be used to record imagery.
If i or my child are ill or have tested positive for COVID,
I/we will not attend.
For DOE staff/contractors or those attending in capacity of DOE Only:
The State shall be responsible for the damages or injury caused by the State, its agents, 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. PAF shall be responsible for damages or injury caused by PAF, its agents, officers, and employees. In the course of their employment to the extent that PAF liability for such damage or injury has been determined by a court or otherwise agreed to by PAF. amd PAF shall pay for such damage and injury to the extent permitted by law.
If you are Staff, volunteers, contractors or others in acapacity of PAF:
I understand that community work days are not part of specific work duties, unless specified in my work contract, and are undertaken by me in the role of volunteer. Any injuries sustained are not part of my work duties, nor the responsibility of the PAF Ohana, and are my personal liability.
________________________________________
I have had the opportunity to read this entire document, and agree to be bound by its terms. I release, relinquish, and forever discharge PAF Ohana from any and all claims any and all causes of action that I (and minor children accompanying me, if applicable) have or may have, past, present or future, known or unknown, anticipated or unanticipated.
I agree to these terms
Signature
(Required)
Phone
This field is for validation purposes and should be left unchanged.
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