2024 Liability Insurance Waiver

Paddlesport Risk Management LLC
2024 Participant Release of Liability

Kailua Canoe Club is covered by two separate insurance policies. We appreciate your understanding by filling out an additional waiver.
CHECK ONE:*

Club MemberGuest Paddler
Guest Participation Date:

MonthDayYear
Date
Participant Full Name*
Street Address*
City, State, Zip*
Email*
example@example.com
Home Phone*
Please enter a valid phone number.
Adult Paddler Signature (MINOR PADDLERS sign below)

Clear
Emergency Contact Name*
Emergency Contact Phone*
Please enter a valid phone number.
Today's Date*

MonthDayYear
Date
Is the paddler a minor?*

YesNo
Minor's Date of Birth

MonthDayYear
Date
Parent/Legal Guardian Name & Address
Please Print name of Custodial Parent or Guardian
Parent/Legal Guardian Name & Address (PLEASE PRINT)
Emergency Contact #
Please enter a valid phone number.
Signature of Parent/Legal Guardian

Clear
Today's Date

MonthDayYear
Date
Should be Empty: