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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Reason for stay and/or name of group you are here with:
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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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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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