2024 HCRA Waiver

Hawaiian Canoe Racing Association Insurance Program
Adult and Minor Waiver and Release of Liability

Canoe Club*

Full Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Birth Date*

Date

Gender (Male / Female / X)*

Home Phone*

Please enter a valid phone number.

Work Phone

Please enter a valid phone number.

Cell/Pager

Please enter a valid phone number.

Email*

example@example.com

Emergency Contact Name*

Emergency Contact Phone*

Please enter a valid phone number.

If a minor, Parent or Guardian

Please Print name of Custodial Parent or Guardian

In consideration of being allowed to participate in any way in the 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 theybelieve anything is unsafe, they will immediately advise their coach or supervisor of such condition(s) andrefuse to participate.

2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk ofserious injury, including permanent disability and death, and severe social and economic losses which mightresult not only from their own actions, inactions or negligence, but the action, inaction or negligence ofothers, the rules of play, or the condition of the premises or of any equipment used. Further, that there maybe 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 the Hawaiian Canoe Racing Association, its memberassociations, its affiliated clubs, their respective administrators, directors, agents, coaches, and othervolunteers 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 hereinafterreferred to as “releasees”, from demands, losses or damages on account of injury, including death or damageto property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise.

The undersigned custodial parent or legal guardian acknowledges t ha t he/she is also signing this release on behalf of the minor participant, that he/she is waiving certain rights on behalf of the minor participant that t he minor participant otherwise may have and that t he minor participant s hall be bound by all of the terms of this release. By signing this waiver and release wit hout a parent’s or guardian’s signature, the participant represents he/s he is at least 18 years of age, or, if signing as t he pare nt or guardian of the participant, signer represents t hey are t he custodial parent or legal guardian of the minor participant.

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

Signature*

Today's Date*

Date