Ho'oilina Foundation

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RELEASE OF LIABILITY

I, ________________________________, make the following representations:

  1. I am in good health.
  2. I have no known ailments which could prevent me from participating in passive and active exercise, workouts, practices, competitions, and other activities (collectively, “Activities”) at _________________________.
  3. I choose to participate in these Activities at my own risk:
  4. I acknowledge that these Activities are potentially dangerous;
  5. I realize the dangers involved, including, but not limited to, soft tissue injuries ( such  as muscle strains and torn ligaments), broken bones, exhaustion, over-exertion, falls and physical contact with other participants and users of facilities;
  6. I appreciate and agree to accept all risks of injury;
  7. I agree that _________ their respective employees, volunteers, instructors and contractors shall not be liable for any injury of damage that I sustain from the use of the facilities, the Activities at ___________, or from other related events, competitions or workouts held away from _______________.
  8. I assume full responsibility for any and all injury and/or damage that may occur to me inn connection with my participation inn any and all of the above, and , on behalf of myself, my heirs, guardians, legal representatives, successors and assigns, I fully and forever release and discharge the Instructors form any and all claims, liabilities, demands, and causes of action, known or unknown, anticipated or nor, resulting from or arising out of my participation of the various activities, and any related events, and my use of this facility.
  9. I understand that thee Instructors neither individually nor collectively carry health or medical insurance for the participants in activities at ______________ or elsewhere.
  10. I am solely responsible for my own health ad medical insurance, if any realizing that related activities involve extreme exercise and physical contact and are potentially dangerous activities.
  11. I have carefully read fully understand this agreement and its contents.

Name of participant:__________________________________D.O.B.:_______________

Signature of participant:_______________________________

If participant is under age 18, parent or legal guardian must also sign below. I AM THE PARENT OR LEGAL GUARDIAN OF THE MINOR WHOSE NAME APPEARS ABOVE. I CONSENT AND AGREEE TO THE ABOVE TERMS FOR MYSELF AND ON HIS OR HER BEHALF AND REPRESENT THAT I HAVE THE AUTHORITY TO GIVE CONSENT. IHAVE CAREFULLY READ THIS AGREEMENT AND RELEASE OF LIABILITY AND FULLY UNDERSTAND ITS CONTENTS.

Name of parent or legal guardian:_______________________________________

Relationship to minor (circle one): father       mother         legal guardian

Signature:___________________________________________

Phone numbers:________________________________________