WAIVER TEXT
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                      CAMP MEKOKIKO WAIVER AND RELEASE OF ALL

                            LIABILITY AND ASSUMPTION OF RISK

(Print, fill out, sign, and return with payment.  Use one each for multiple families or individuals)

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____________________________________________________________ / Family?  (Y)_________
NAME / ( FAMILY? )

 

 ______________________

AGE IF MINOR or # PEOPLE THIS WAIVER COVERS IF FAMILY

 

___________________________________________________________________________________
ADDRESS CITY STATE ZIP

 

 

(_______)__________________________________________

PHONE

 

___________________________________________________________________________________

EMAIL ADDRESS

A. In consideration of the privilege and pleasure to be derived by me, my family and friends and all others who use the Mekokiko Camp (“the Camp”), I hereby pledge that I am responsible for my own safety and that I ASSUME ALL RISKS OF INJURY AND ALL RESPONSIBILITY AND LIABILITY FOR ALL ACTS OR ACTIVITIES of myself and my family for any and all damages or injury that may be caused by us in any way growing out of or resulting from the use and occupancy of the Camp.

The Camp includes the improvements and all other natural or man-made features as detailed in our Policies and Rules.

B. I HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE
HAWAII DISTRICT UNITED METHODIST UNION, CALIFORNIA-PACIFIC ANNUAL
CONFERENCE, OR ANY OF THEIR INSURERS, OFFICERS, DIRECTORS, SHAREHOLDERS, AGENTS, EMPLOYEES OR OTHERS RENDERING SERVICES (hereinafter “THE CAMP, ET AL.”) from and for any and all bodily injury, death or property damage which in any way grows out of or results from any activity sponsored or conducted by THE CAMP, ET AL., whether any such claims
may be based upon alleged active or passive negligence, or otherwise, or upon participation in the wrong, or upon any alleged breach of any statutory duty or obligation.

C. I HEREBY AGREE TO INDEMNIFY, DEFEND AND SAVE AND HOLD HARMLESS
THE CAMP, ET AL., from all loss, liability, damage, or costs which THE CAMP, ET AL., may incur for any and all losses or damages for bodily injury, death or dismemberment, or damage to property which in any way is caused to me or by me or results from the activities of any person who is at the Camp at my invitation.

D. I HEREBY AGREE to follow all rules and policies for the Camp, and to use due care to avoid injury to myself or others.

E. I EXPRESSLY AGREE THAT THIS WAIVER OF LIABILITY AND ASSUMPTION
OF RISK is intended to be as broad and all inclusive as is permitted by law. If any portion hereof is held invalid or unenforceable, I agree that the balance shall, notwithstanding, continue in full legal force and effect.

F. BY SIGNING BELOW, I WARRANT that I fully understand this Waiver of Liability and Assumption of Risk and that I am agreeing on behalf of myself and my estate, heirs, assigns and representatives not to sue THE CAMP, ET AL., or hold them liable for any injuries, including death, resulting from activities at THE CAMP, ET AL. I fully understand and intend to be bound by this agreement and affirm that I am eighteen (18) years of age or older, and under no legal disability.

________________________________________________________________ / _________________
SIGNATURE OF RESPONSIBLE PARTY / DATE

 

_________________________________________________________________ / _________________
or CONSENT BY MINOR’S PARENT OR GUARDIAN

 

_______________________________________________________________ / __________________
NAME OF MINOR / AGE OF MINOR

I represent that I am the parent or legal guardian of the minor named above. I have read and fully understand this Waiver of All Liability and Assumption of Risk agreement and by signing below consent to all terms and conditions of this agreement on behalf of the minor and the minor’s family, heirs and personal representatives.

_______________________________________________________________ / __________________

SIGNATURE OF PARENT OR GUARDIAN DATE

 


________________________________________________________________ / _________________

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