New MEMBER Registration Form

ALMA JEAN FOUNDATION

84-1300 Maunaolu St.

Waianae, HI 96792

www.ajfhawaii.com
AJF Program Interest:
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ALMA ClinicsALMA Elite CampALMA ScholarshipALMA Leadership Camp
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Disclaimer and Signature:

I verify that I have read this application thoroughly and that the information provided are true and complete to the best of my knowledge.
Student Athlete Signature :*

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Parent Signature:*

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Date*

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Waivers of Liability

The following pages include (2) different Waivers of Liability.

ALMA JEAN FOUNDATION

84-1300 Maunaolu St.

Waianae, HI 96792

www.ajfhawaii.com
Waiver of Liability
This release and Waiver of Liability (the "Release") executed on this Day* day of Month* , 20 Year* by guardian/parent(s) and minor release in favor of the ALMA JEAN FOUNDATION, a nonprofit corporation organized and existing under the laws of the State of HAWAII, USA and their directors, officers, employees, and agents (collectively, "ALMA JEAN FOUNDATION").
I, First Name Last Name, a student-athlete for ALMA JEAN FOUNDATION engage in the activities related to being a memberfor the foundation. I hereby freely and voluntarily, without duress, execute this Release under the following terms:
1. Waiver and Release. I release and forever discharges and hold harmless ALMA JEAN FOUNDATION and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the my volunteer work at ALMA JEAN FOUNDATION. I understand and acknowledges that this Release discharges ALMA JEAN FOUNDATION from any liability or clam that I may have against ALMA JEAN FOUNDATION with respect of bodily injury, personal injury, illness, death, or property damage that may result from participation on the ALMA JEAN FOUNDATION fundraiser/ program site. It is also understood that ALMA JEAN FOUNDATION does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance in the event of injury, illness, death or property damage.

2. Insurance. I understand that I expressively waive any such claim for compensation or liability on the part of ALMA JEAN FOUNDATION beyond what may be offered freely by the representative of ALMA JEAN FOUNDATION in the event of such injury or medical expense.

3. Medical Treatment. I hereby and forever discharge ALMA JEAN FOUNDATION from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my time with ALMA JEAN FOUNDATION.

4. Assumption of Risk. I understand that my time with ALMA JEAN FOUNDATION may include activities that may be hazardous to them including, but not limited to, construction activities, loading and unloading of heavy equipment and materials, and local transportation to and from fundraiser/ program sites. We recognize and understand that my time with ALMA JEAN FOUNDATION may, in some situations, involve inherently dangerous activities (working around vehicles and roadways). I hereby expressly assume the risk of injury or harm in these activities and release ALMA JEAN FOUNDATION from all liability for injury, illness, death or property damage resulting from the activities of my times at ALMA JEAN FOUNDATION.

5. Photographic Release. I grant and convey unto ALMA JEAN FOUNDATION all right, title, and interest in all photographic images and video or audio recordings made by ALMA JEAN FOUNDATION during my volunteer time with ALMA JEAN FOUNDATION.

6. Other. As the student athlete I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of HAWAII in the United States of America, and that this Release shall be governed by and interpreted in accordance with the laws of the State of HAWAII. I agree that in the event that any clause or provision shall no otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
Student Athletes 18 years and over: To express my understanding of this Release, sign here. (Skip this section if student athlete is a minor)
Print Name   First Name   Last Name
Signature of Member Signature
Date:   Date
Medical Insurance? Yes No
Medical Coverage Carrier:   Type a label
Medical Coverage/ Identification #:   Type a label
If student athlete is under the age of 18 years, please have parent/legal guardian fill out below: To express my understanding of this Release, I sign here.
Print Name of Legal Guardian   First Name   Last Name
Name (s) of dependent (s)/ minor(s)   Type a label
Signature of Parent/Guardian Signature
Date:   Date
Address: blank
Phone Number:   Area Code   Phone Number
Medical Insurance? Yes No
Medical Coverage Carrier:   Type a label
Medical Coverage/ Identification #:   Type a label

kuulei@petersonfarmco.com
Waiver of Liability
This release and Waiver of Liability (the "Release") executed on this Day* day of Month* , 20 Year* by the guardian/parent(s) and minor release in favor of the PETERSON FARM CO., a LIMITED LIABILITY corporation, PETERSON BROS. CONSTRUCTION, INC., a corporation, ALMA JEAN FOUNDATION, a non-profit, organized and existing under the laws of the State of HAWAII, USA and their directors, officers, employees, agents, and tenants. The Peterson Farm is located at 86-416 Halona Road. Waianae, HI 96792.
I, First Name* Last Name* or (Name of Guardian(s) First Name* Last Name*, the legal guardians of (list name of minors in family) Minor Names* , hereby freely and voluntarily, without duress, execute this Release under the following terms:
1. Waiver and Release. The guardian/parent(s) and minor release and forever discharges and hold harmless PETERSON FARM CO., PETERSON BROS. CONSTRUCTION, INC., ALMA JEAN FOUNDATION, DANIEL AND JOY PETERSON, and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the minors participation at THE PETERSON FARM located at 86-416 Halona Rd. Waianae, HI 96792 . I understand and acknowledges that this Release discharges PETERSON FARM CO., PETERSON BROS. CONSTRUCTION, INC., ALMA JEAN FOUNDATION, DANIEL AND JOY PETERSON from any liability or clam that I may have against PETERSON FARM CO., PETERSON BROS. CONSTRUCTION, INC., ALMA JEAN FOUNDATION, DANIEL AND JOY PETERSON with respect of bodily injury, personal injury, illness, death, or property damage that may result from participation on the PETERSON FARM CO., PETERSON BROS. CONSTRUCTION, INC., ALMA JEAN FOUNDATION, DANIEL AND JOY PETERSON site. It is also understood that PETERSON FARM CO., PETERSON BROS. CONSTRUCTION, INC., ALMA JEAN FOUNDATION, DANIEL AND JOY PETERSON does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance in the event of injury, illness, death or property damage.

2. Insurance.The guardian/parent and minor understands that we waive any such claim for compensation or liability on the part of PETERSON FARM CO., PETERSON BROS. CONSTRUCTION, INC., ALMA JEAN FOUNDATION, DANIEL AND JOY PETERSON beyond what may be offered freely by the representative of THE PETERSON FARM located at 86-416 Halona Rd. Waianae, HI 96792 in the event of such injury or medical expense.

3. Medical Treatment. The guardian/parent and minor hereby release and forever discharge PETERSON FARM CO., PETERSON BROS. CONSTRUCTION, INC., ALMA JEAN FOUNDATION, DANIEL AND JOY PETERSON from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during the minors time on THE PETERSON FARM located at 86-416 Halona Rd. Waianae, HI 96792.

4. Assumption of Risk. The guardian/parent(s) understands that the minor's time on THE PETERSON FARM may include activities that may be hazardous to them including, loss of balance; difficulty or inability to control one's speed and direction; variation or steepness in terrain; rapid or uncontrolled acceleration on hills and inclines; mechanical failure of equipment; variation or changes in the playing surface inluding rocks, gravel; changing weather conditions; exposure to temperature extremes on inclement weather; collision with existing structures, trees, shrubs, plants, pedestrians, motor vehicles, cyclists, and other players; failing to play safely or within the limitations of one's own abilities, negligence of other participants;

5. As the parent/guardian for the said minor(s) I hereby expressly assume the risk of injury or harm in these activities and release PETERSON FARM CO., PETERSON BROS. CONSTRUCTION, INC., ALMA JEAN FOUNDATION, DANIEL AND JOY PETERSON from all liability for injury, illness, death or property damage resulting from the activities of minors time at THE PETERSON FARM located at 86-416 Halona Rd. Waianae, HI 96792

6. Other. The guardian/parent and minor expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of HAWAII in the United States of America, and that this Release shall be governed by and interpreted in accordance with the laws of the State of HAWAII. The guardian/parent and minor agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall no otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
Student Athlete 18 Years and Older
Print Name of Student-Athlete   First Name   Last Name
Signature of Member Signature
Date:   Date
Medical Insurance? Yes No
Medical Coverage Carrier:
Medical Coverage/ Identification #:
If student athlete under the age of 18 years, please have parent/legal guardian fill out below: To express my understanding of this Release, I sign here.
Print Name of Legal Guardian   First Name   Last Name
Name (s) of dependent (s)/ minor(s)
Signature of Parent/Guardian Signature
Date:   Date
Medical Insurance? Yes No
Medical Coverage Carrier:
Medical Coverage/ Identification #:
Should be Empty:

New Student-Athlete MEMBER Registration Form

Student Athlete Information:

School Information:

Sports Information:

Parent/Guardian Information:

AJF Program Interest:

Disclaimer and Signature:

Waivers of Liability

Waiver of Liability

Waiver of Liability