Hawaii Land Trust · Acknowledgment of Outing Member Responsibility, Express Assumption of Risk, and Release of Liability

Acknowledgment of Outing Member Responsibility, Express Assumption of Risk, and Release of Liability Document

Agreement

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I have had the opportunity to read the Acknowledgment of Outing Member Responsibility, Express Assumption of Risk and Release of Liability Document dated 08/02/2021 linked to above in its entirety and I freely and voluntarily assume all risks of such Injuries and Damages and notwithstanding such risks, I agree to participate in HILT’s outing.

Is this waiver for, or does it include, a minor(s) under 18 years old?

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Name of minor(s)

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List all minors separated by a comma.

Attending

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I will be attending the event with the listed minors; this waiver covers me as well.

The listed minors will be attending the event with another adult.

Parent/Guardian Release for participants under eighteen (18) years of age.

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I certify that I am the parent or legal guardian of the above named participant and that I have had the opportunity to read the foregoing Acknowledgment of Outing Member Responsibility, Express Assumption of Risk and Release of Liability and hereby execute this Acknowledgment of Outing Member Responsibility, Express Assumption of Risk and Release of Liability on behalf of the above-named minor and on my own behalf. I hereby relinquish any claim that I might have against the Partners, their employees, agents, contractors, directors and the predecessors, successors, assigns, affiliates, subsidiaries and parents of each, both in my own behalf and in my capacity as legal representative of the minor.

Your support allows us to further our mission to protect the lands that sustain us for current and future generations. Mahalo nui!

$100

$50

$25

$

Let us know to expect you:

Event Location

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Enter the location you are planning to attend.

Event Date

Identify the date that you will be attending. This waiver is good for one year.

Event Type

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What is the reason for this particular visit?

Native Hawaiian Ancestry

This information will remain secure. HILT will never share your personal information outside the organization. We collect the data and report, in aggregate, the impacts of our work on Native Hawaiian communities throughout the islands. HILT seeks this information because it is important to us to connect the Native Hawaiian community with land under our stewardship. Additionally, some of our funding sources, such as the Office of Hawaiian Affairs, require that we track Native Hawaiian participation in some of our programs.

Native Hawaiian Ancestry Selection

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Please indicate if you or your minor(s) covered by this form are of Native Hawaiian ancestry

Yes

No

Prefer not to say

Contact Information

Your Contact Information as Parent/Guardian:

Name

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First Name

Last Name

Group Name

Please let us know if you are part of a particular attending group.

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

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Email

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Verify Email

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Max One Adult Per Form

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Check here to confirm that this form covers no more than one adult with or without minors, other adults will fill their own waiver forms.

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