Hawaiian Canoe Racing Association Insurance Program
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1 Hawaiian Canoe Racing Association Insurance Program Canoe Club: Adult and Minor Waiver and Release of Liability January 1, 2019 to December 31, 2019 In consideration of being allowed to participate in any way in the Hawaiian Canoe Racing Association and its member organizations athletics/sports programs, and related events and activities, the undersigned: The undersigned custodial parent or legal guardian acknowledges that he/she is also signing this release on behalf of the minor participant, that he/she is waiving certain rights on behalf of the minor participant that the minor participant otherwise may have and that the minor participant shall be bound by all of the terms of this release. By signing this waiver and release without a parent s or guardian s signature, the participant represents he/she is at least 18 years of age, or, if signing as the parent or guardian of the participant, signer represents they are the custodial parent or legal guardian of the minor participant. THE UNDERSIGNED HAVING READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT THEY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY. Paddler Name (print) Sex F M Street Address Birthdate City State Zip Code Phones: Home Work Cell/Pager Address IN AN EMERGENCY CONTACT: Phone If a minor, Printed Name of Custodial Parent or Guardian Adult/Paddler Signature: Date (Adult Paddler or Minor s Guardian)
2 Aloha (New and Returning Paddlers) 2019 Regatta Racing Season!! Registration Packet Guidelines Please complete ALL required paperwork. (HCRA waiver, WCC application form, Photo release waiver, Liability for injuries form) All registration dues must be paid in full at time of registration, Only PAID IN FULL members will be allowed to participate in sanctioned or non-sanctioned races. Water safety and safety measure will be exercised at ALL times. Any negligence on the part of any member/paddler that result in an unsafe condition may result in termination of membership. NO DRUGS ALLOWED! RESPECT yourself, others and Waimānalo Canoe Club at all times. Canoes and equipment are to be used only under the direction of Waimānalo Canoe Clubʻs Head Coach Nolan Reis-Moniz. All members will be held responsible for any/all damages incurred to any club equipment due to negligence and/or improper use. Expectations Pay ALL membership dues when due. Help out when any type of work is being done. Remember itʻs a kākou thing, you should never find yourself standing around or watching others doing something. You are expected to participate in cleaning our area both at the hālau, Kaiona and at the race site before you leave. Be at practice ready to go on time, every time. If you canʻt make it or are going to be late let your coach know, give them a call or leave a message. This will enable your crew to go on without you and not waste canoe time. Be considerate of others. No one is allowed to leave the races (before or after their events) without permission from the coach. Be sure your coach/designated person knows where you are at all times. Stay healthy at all times, always bring a jacket and water bottle, towel and extra clothes. Basic Care of Equipment Always be sure the canoes are on tires or cradles while on the beach or on land. No sitting on the canoes while on land. No stepping over thing, please walk around. That means, people, paddles, canoes, etc. This also includes the ʻiako and ʻama. If you are unable to walk under them, please be safe as you step over them. When carrying Ke Alaula, DO NOT lift her by the seat. Grab the cleat that is part of the hull. Please stand your paddle up against something and never leave it lying on the ground. Your paddle (or WCC paddles) is an extension of your body, treat it with respect, take care of it, do not dig the edge of your paddle in the sand or use it as a shovel, etc. Before any canoe enters the water all paddlers should ensure the canoe has at least two bailers.
3 Fundraisers As an active member of Waimānalo Canoe Club, I understand that I will be responsible to actively participate in all the fundraising events. I am responsible to sell ALL tickets or items issued to me for any fundraising event. I will be responsible to pay for any unsold or lost amounts. No tickets or items may be returned once issued to me. Registration Dues and Fees *Due on or before April 30, 2019 Waimānalo Adult Dues Returning Paddler $170 New Paddler - $180 Associate / Recreational Paddler $105 Waimānalo Keiki Dues Returning Paddler $160 New Paddler - $170 Late Registration: You may not receive a regatta jersey. If you should need to work out a payment plan and pay the full dues over time please make that request with the Treasurer/registrar. All requests must be made to and approved by the Treasurer. ʻOhana Discount: 2 or more (must be immediate family only) = 8% Discount NO REFUNDS AFTER MAY 1st, 2019 Items required to register. Canoe Club Application for Membership HCRA 2019 Waiver Form Canoe Club - Photo Release Waiver Form Canoe Club Liability for Injury Form (Adult / Minor) Copy of ID: (driver s license, birth certificate anything that shows your name, birthdate / gender) Dues: (cash/check payable to Waimanalo Canoe Club), Non-paid paddlers will NOT be allowed to race Photo: We will take a photo of all new paddlers and paddlers who s ID cards have expired (no hats or sunglasses) to register with TeamSnap and complete online registration with TeamSnap. Inter-Island Travel 2019 HCRA State race location is tentatively scheduled to be held on the island of Kauai Queen Liliuokalani Race(s), held on the Big Island, to be determined by Heal Coach, Nolan Reis-Moniz.
4 Waimānalo Canoe Club Application for Membership Dues: B/C: ID: Waiver : NAME (LAST, FIRST, MI): NICKNAME: ADDRESS: CITY: ZIP: GENDER AT BIRTH: Male Female BIRTHDATE: AGE (ON JAN 1 ST ): CELL PHONE: HOME PHONE: CAN YOU SWIM? YES: NO: JERSEY SIZE: YM YL S M L XL XXL 3XL 4XL (Circle/Specify 1 Size Only, Y = Youth Size) LAST CLASSIFICATION: KEIKI (AGE 8-11) JUNIORS (AGE 12-18) NOVICE B NOVICE A OPEN MASTERS Are you transferring from another Canoe Club? Yes No Name of Club and Classification: DO YOU HAVE ANY MEDICAL PROBLEMS: IF YES, PLEASE SPECIFY: EMERGENCY CONTACT: NAME: RELATIONSHIP: PHONE: MEDICAL COVERAGE: FAMILY PHYSICIAN: PHONE: INSURANCE: POLICY#: SUBSCRIBER: SUBSCRIBER ID: GROUP#: *I understand that I am responsible to sell ALL tickets or items issued to me for any fundraising event, I will be responsible to pay for any unsold or lost amounts. No tickets or items may be returned once issued to me. (INITIAL) *I understand that my club membership/registration fees are payable on or before April 1, 2019, and there will be NO refunds of fees after May 1, (INITIAL) *I understand that if I register after April 15, 2019, I may not receive a jersey. (INITIAL) MEMBER SIGNATURE: DATE: TO BE COMPLETED FOR ALL MINOR APPLICANTS: I PARENT/GUARDIAN OF DO HEREBY AUTHORIZE MY CHILD TO PARTICIPATE IN THE 2019 CANOE RACING SEASON AS A MEMBER OF WAIMANALO CANOE CLUB INC. PRINT NAME SIGNATURE DATE
5 Media Release Waiver I grant to Waimanalo Canoe Club Inc., its representatives and employees permission to record on photography film and/or video, pictures of my participation in connection with all club sponsored activities. I authorize Waimānalo Canoe Club Inc., its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Waimānalo Canoe Club, Inc. may use such photographs, films and/or video of me with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration advertising, and web content. I further agree that such use shall be without payment of fees, royalties, special credit or other compensation. I have read and understand the above and by signing below attest to such. Member Signature Printed name Organization name (if applicable) Address Date To be completed for all minor members Printed name of parent/guardian Signature of parent/guardian _
6 Waimānalo Canoe Club Adult Membership Waiver PLAIN LANGUAGE RELEASE FROM LEGAL LIABILITY FOR INJURIES This release is executed on 20 _, between ( Releaser ), of Honolulu, Hawaii, and the Waimānalo Canoe Club ( CLUB ), of Honolulu, Hawaii. I, Releaser, being over the age of 18 years, in consideration of being permitted to participate in the sport of canoe paddling with the CLUB, do hereby release and hold harmless the CLUB from any and every claim, demand, action or right of action, of whatever kind or nature arising from or by reason of any injury to me known or unknown death, or property damage resulting from any accident which may occur because of participating in canoe paddling or any activities in connection with canoe paddling (including social activities), whether by negligence or not. I further release all members and coaches from any claim whatsoever I may have on account of first aid, treatment or service rendered me during my participation in this sport. This release contains the entire agreement between the TEAM and me and the terms of this release are a contract. I have read this release, I understand it, and I sign it as my own free act. I understand that before I sign, I may have my attorney review this release and he or she can explain in detail the full extent of the legal rights I am giving up. IN WITNESS WHEREOF, Releaser has executed this release at Honolulu, Hawaii, the day and year first above written. Member Signature Name (Please Print)
7 Waimānalo Canoe Club Membership Waiver for Minors PLAIN LANGUAGE RELEASE FROM LEGAL LIABILITY FOR INJURIES This release is executed on 20 _, between ( Releaser ), in behalf of my child of Honolulu, Hawaii, and the Waimānalo Canoe Club ( CLUB ), of Honolulu, Hawaii. I, Releaser, being over the age of 18 years, in consideration of being permitted to participate in the sport of canoe paddling with the CLUB, do hereby release and hold harmless the CLUB from any and every claim, demand, action or right of action, of whatever kind or nature arising from or by reason of any injury to me known or unknown death, or property damage resulting from any accident which may occur because of participating in canoe paddling or any activities in connection with canoe paddling (including social activities), whether by negligence or not. I further release all members and coaches from any claim whatsoever I may have on account of first aid, treatment or service rendered me during my participation in this sport. This release contains the entire agreement between the TEAM and me and the terms of this release are a contract. I have read this release, I understand it, and I sign it as my own free act. I understand that before I sign, I may have my attorney review this release and he or she can explain in detail the full extent of the legal rights I am giving up. IN WITNESS WHEREOF, Releaser has executed this release at Honolulu, Hawaii, the day and year first above written. Print name of member Parent/Guardian Signature Print Parent/Guardian Name _
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