Registration

 

____________________________

 KCAA and the County of Hawaii Dept. of Parks and Recreation

REGISTRATION, CONSENT, & RELEASE OF CLAIMS FORM

Participation in sports sponsored by KCAA is limited to the North Kohala Community

____________________________

Fields marked with an * are required

YOUTH INFORMATION

SHIRT SIZE - Select One

PARENT/GUARDIAN INFORMATION

FATHER/GUARDIAN

MOTHER/GUARDIAN

EMERGENCY CONTACT OTHER THAN PARENT/GUARDIAN


LOCATION
District: North Kohala
Facility: Kamehameha Park

ACCESSIBILTY

If yes, please complete a Modification Request with our Recreation Specialist, phone  961-8681.
Adult attendants or skills trainers who accompany a child

must register before the first day of the program.

MEDIA RELEASE

We hereby give permission to the Department of
Parks & Recreation, County of Hawaii,to allow the
news media to film and photograph program activities provided:

  1. They are for news and non-commercial purposes.
  2. The program director determines the filming, etc., will not
    unduly interfere with or disturb the programs.
  3.  Individual children are not singled out for demonstrating
    photography or interview purposes against their wishes.

INFORMED CONSENT AND
ASSUMPTION OF RISKS

INFORMED CONSENT AND ASSUMPTION OF RISKS

The Department of Parks and Recreation provides a wide variety of activities and programs for persons of all ages in a safe and pleasant environment. However, there are certain inherent risks in almost every activity. Please read the following informed consent categories to acquaint yourself with the risks involved. If you are making a determination that you child is able to participate in any activity, it is your responsibility to assess your child's maturity, health/fitness and ability to obey safety rules, and decide if the risks associated with these activities are acceptable to you. While the County of Hawaii hopes that every participant enjoys an injury-free activity, by your signing this Release of Claims form, you assume all risks associated with the activity for which you have registered your child. Please ask any questions of the instructor which you may need to make a fully informed decision for your child to participate.

Certain sport activities, such as football, basketball, baseball and volleyball may have physical contact. All contact sports necessarily and unavoidably carry with them the risk of high speed collisions with other persons, balls, and equipment. In addition, irregular playing surfaces may be present and a child may be at risk for falling or minor lacerations. There are, therefore, risks of orthopedic, dental, cervical, spinal, head or other types of injury. There is also the risk of lacerations and other injury from falling and/or colliding with people or objects.

In addition, all sports require a level of fitness and health that only your physician can determine your child possesses. We strongly urge that you obtain medical advice as to whether contact sport activities are suitable for your child. Many undetected or chronic diseases such as cardiac disease or high blood pressure may be worsened by participation in these activities.

RELEASE OF CLAIMS AND INDEMNIFICATION

In consideration of permission granted to participant by the County of Hawaii, Department of Parks and Recreation, to participate in the activities listed above:

I/we hereby release the County of Hawaii, its agents, employees, and independent contractors from all actions, causes of action, damages, claims, or demands which I, my heirs, personal representatives, or assignees may have against the County of Hawaii, and other above-named parties for all injuries, known or unknown, which may occur by my child's participation in the above-described activity or by my child's use of the above-described Facility.

I/we do further agree that I shall indemnify and save harmless the County of Hawai'i, or any of its officers or employees, either jointly or severally, from any and all claims, demands, damages, loss of service, or expense for property damage and for personal injuries or actions brought by a third party resulting or arising from my child's participation in the above-described activity or my child's use of the Facility.

Parent/Guardian will be responsible for transportation of your child to and from practices and games. KCAA and its volunteers and affiliates will not be held liable for any accidents, injuries, or deaths resulting from participation or transportation in any of its programs, practices, or games.

PARTICIPANT'S & PARENT'S CODE OF CONDUCT

  1. I will encourage, but not force, my child to participate in any program or event.
  2. I will remember that children participate to have fun, and that the program/event is for youth, not adults.
  3. I will pay close attention to the physical conditioning and well-being of my child, and will refuse to jeopardize the health of any individual for the sake of improving a person's or team's chance to win.
  4. I will not ridicule or yell at my child or any other participant for making a mistake or losing.
  5. I (& guests) will be positive role models for my child, and encourage sportsmanship by showing respect and courtesy, and by demonstrating positive support for all staff, players, coaches, officials, and spectators at every game, practice, tournament, or event.
  6. I will respect officials and their decisions. I will not argue with an official in public, and will not yell, swear or be verbally abusive. Any discussion or constructive comment shall be done in an unemotional and calm manner.
  7. I will not engage in any physical or verbal confrontation or altercation before, during or after any program, game or event, with officials, coaches, players, staff, or spectators. Doing so shall result in immediate action by the police and the Director of the Department of Parks & Recreation.
  8. All P&R Activities are drug and alcohol free for participants and adults. Anyone found to be under the influence, intoxicated, or in possession of any of these will be TERMINATED from participating in the program. The Police and the Director of the Department of Parks & Recreation will be notified. 

CONSENT

In consideration of the permission granted to me by the County of Hawai'i, State of Hawaii, for my minor child ("Child") to participate in the above-mentioned sport/activity ("Activity"), the above-named PARENT/LEGAL GUARDIAN ("Parent") consents and agrees that:

  1. Child is allowed to actively participate in Activity;
  2. Child is participating voluntarily, and with Parent's approval and consent.
  3. Child is in reasonably good physical and mental health, such that Minor can safely participate in Activity.
  4. Parent recognizes and understands that participation in the
    Activity involves risk of death, personal injury
    and/or property damages, commonly inherent in such Activity.
  5. Parent shall notify a representative from the Department of Parks and Recreation if there is any change in Child's physical and/or mental condition such that MINOR cannot safely
    participate in Activity.

I also agree:

  1.  I have read this registration form,
    including the Informed Consent, Assumption of Risks,
    Code of Conduct, and Release of Claims.
  2. I understand and agree with all of its terms.
  3. I have filled out the information on this form fully and completely.
  4. I will notify the County immediately in writing of any changes to the information above.
  5. I am signing this form voluntarily and with full knowledge of its significance.
IN WITNESS WHEREOF,
I have executed this Registration, Consent
and Assumption of Risks, Release of Claims and Indemnification, and Code of Conduct
at North Kohala on the day and year listed below :

Possession or consumption of alcohol by persons
under 21 is prohibited.

County of Hawaii is an Equal Opportunity Provider and Employer

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