Hawaiian Canoe Racing Association Insurance Program

MINOR Waiver and Release of Liability

April 1, 2008 to March 31, 2009

In consideration of being allowed to participate in any way in Hawaiian Canoe Racing Association and its member organizations athletics/sports programs, and related events and activities, the undersigned:

1. Agree that prior to participating, they each will inspect the facilities and equipment to be used, and

if they believe anything is unsafe, they will immediately advise their coach or supervisor of such

condition(s) and refuse to participate.

2. Acknowledge and fully understand that each participant will be engaging in activities that involve

risk of serious injury, including permanent disability and death, and severe social economic losses

which might result not only from their own actions, inactions or negligence, but the action, inaction

or negligence of others, the rules of play, or the condition of the premises or of any equipment

used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.

3. Assume all the foregoing risks and accept personal responsibility for the damages following such

injury, permanent disability or death.

4. Release, waive, discharge and covenant not to sue Hawaiian Canoe Racing Association, its member

associations, its affiliated clubs, their respective administrators, directors, agents, coaches, and other

volunteers or employees of the organization, other participants, sponsoring agencies, sponsors,

advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which

are hereinafter referred to as “releasees” from demands, losses and damages on account of injury,

including death or damage property, caused or alleged to be caused in whole or part by the negligence

of the releasee or otherwise.

THE UNDERSIGNED HAVING READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT THEY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY.

Minor’s Name (Print Name) ___________________________________________Gender: _____F _____M

Street Address_____________________________________________Birthdate: _______________

City___________________________ State ___________________ Zip Code _________________

Home # ____________________Work #______________________Cell #____________________

Custodial Parent (Print Name) ________________________________________Date_____________

Signature of Custodial Parent _____________________________________________________

CANOE CLUB _______________________________________________________

In the event of an emergency: Contact Person _______________________________________________

Home phone #________________________ Work #______________________Cell #____________________