PKCC 2026 Release Form
This form is to be completed by all Adults and the Parents/Legal Guardians of minors who are staying here at Pu'u Kahea Conference Center. Please read carefully before signing this form.
Guest information (Parents/Guardians can fill out multiple entries for their children):
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Event or Group Name
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Please Select
New Hope JRHI Youth Camp
New Hope HighSchool Youth Camp
King's Chapel Day Camp
Korean Pastor's Association
Church in Honolulu Youth Camp
Hawaii Central Presbyterian Church Retreat
Waiakea Uka Church Mission Team
Pastoral Retreat (Harris)
Hawaii Youth Ministries UPCI Camp
Oklahoma Wesleyan University
Aloha Nani
FBC Pearlcity
United Methodist Church
Hawaii Chinese Baptist Church
King's Chapel Women's Retreat
Leisure
Other
Reason for stay and/or name of group you are here with:
Date of Arrival
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Month
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Day
Year
Date
Date of Departure
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Month
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Day
Year
Date
EVENT DESCRIPTION: I am/My child understand that Pu'u Kahea Conference Center "PKCC" is only providing accommodations and facilities for the stay.
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I understand
ASSUMPTION OF RISK: I hereby expressly and specifically assume all risks of injury, loss, or damage, which I or my child might sustain while staying here at PKCC
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I understand
INDEMNIFICATION AND RELEASE OF LIABILITY: I do further hereby release and discharge from liability and agree to defend, indemnify, and forever hold harmless Hawaii Pacific Baptist Convention (HPBC) and Pu’u Kahea Conference Center (PKCC) , and the volunteers and employees, from any and all causes of action arising from or relating to my/my child’s stay. I understand that I am/my child is solely responsible for my/ his or her personal effects and property and I will hold the Hawaii Pacific Baptist Convention, Pu’u Kahea Conference Center, volunteers, and employees harmless in the event of theft or loss resulting from any source or cause.
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I understand
ADULT VERIFICATION: I verify that I am at least 18 years of age when signing this document and, therefore, an adult.
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Yes, I am the PARTICIPANT and I am at least 18 years of age.
Yes, I am the PARENT/LEGAL GUARDIAN of the minor Participant. Parental Authorization (below) is required.
MINOR PARTICIPANT – PARENTAL AUTHORIZATION:As a PARENT/LEGAL GUARDIAN of the minor Participant(s), I give my permission for the minor(s) listed to stay and agree to the assumption of risks, Indemnification and Release of Liability. I accept responsibility for all medical, health and/or liability expenses which may arise from the minor’s stay. I authorize Pu’u Kahea Conference Center’s designated representative(s) to serve as our attorney-in-fact and vest each of them with authority to authorize any necessary medical treatment for our minor child.
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I understand (For PARENT/LEGAL GUARDIAN)
Not applicable because the Participant is at least 18 years of age (For only ADULT PARTICIPANT)
Signature of Adult Participant or Parent/Legal Guardian: I am an ADULT PARTICIPANT and/or PARENT/LEGAL GUARDIAN of the minor, and I am authorized to sign this form on behalf of myself or any other parent/legal guardian of the minor. By signing my name below using e-signature, I agree to its terms, and have effectively signed the release.
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Your Name (Adult Participant and/or Parent/Guardian):
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First Name
Last Name
Today's Date
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Month
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Day
Year
Date
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Should be Empty: