Emergency Contact

Emergency Contact Phone

Family Physician

Family Physician Phone

Insurance Carrier

Group/Policy Number

Any medical history, allergies, drug reactions, etc. that may be needed for medical treatment:

KONA FAITH CENTER, INC. ACCIDENT/INJURY RELEASE, WAIVER OF LIABILITY, INDEMNITY AGREEMENT, AND ASSUMPTION OF RISK

Name of event: Men's Camp

Date of event: Wednesday, July 23, 2025 - Saturday, July 26, 2025

Time: Wed. July 23rd, checkin by 6pm through Sat. July 26th, checkout by 9am

Location: Kilauea Military Camp

1. I sign this waiver voluntarily with the understanding that I cannot participate without agreement to the terms and conditions that follow. As a parent or guardian, I sign for my minor child under 18.

2. I shall conform to all applicable policies, rules, regulations, and standards of conduct established by the State/County of Hawaii, and Kona Faith Center, Inc. and will not participate in any illegal activity.

3. I shall accept termination of my participation in this event if I fail to maintain acceptable standards of conduct as established by Kona Faith Center, Inc. and the State/County of Hawaii.

4. In consideration of my participation in Men's Camp and other valuable considerations, the receipt of which is acknowledged, I hereby agree to accept all risk of my health and of my injury or death that may result from such participation and I hereby release, waive, discharge and covenant not to sue Kona Faith Center, Inc., their directors, officers, employees, volunteers, and agents (hereinafter referred to as “Releasees”) from all liability to me, my personal representatives, assigns, heirs, next of kin or anyone else for any loss or damage in any claim or demands therefore, on account of property damage, personal injury or death, whether caused by the negligence of the Releasees or otherwise, arising out of any activity related to this event, including travel to and from this event to the fullest extent permitted by law.

I agree

5. Kona Faith Center, Inc. Releasees are not responsible for the administration of any medications to the Participant during this event. The Releasees are not responsible for any adverse reactions that may occur from taking any personal medications.

6. I agree to indemnify, save and hold harmless the Releasees and each of them from any loss, liability, damage or cost that they may incur due to my participation in this event, including travel to and from this event.

7. I hereby assume full responsibility and risk of bodily injury, death or property damage arising out of participation in this event as named above. I understand that there are certain risks that may occur both known and unknown including but not limited to: exposure to personal injury; accident or illness; forces of nature.

I agree.

8. I further agree that the foregoing Release, Waiver, Indemnity Agreement, and Assumption of Risk is intended to be as broad and inclusive as possible, yet there may be unforeseen risks and will not hold the Releasees responsible in any manner.

9. I hereby grant permission for the performance of any first aid and/or emergency medical treatment that may be required in the case of an accident wherein I am rendered unconscious or unable to approve of the required medical treatment. In the event that I become the victim of an accident I will hold harmless from any liability or negligent actions which may arise in connection with the search and rescue, stabilization, evacuation, transportation, and emergency care I receive while secondary aid resources are being sought.

10. I hereby agree to permit Kona Faith Center, Inc. agents, employees, volunteers, directors, officers, and other guests to take photographs (still or live) and make film records of this event without further recourse. I understand such photographs and/or film may be used for commercial and/or promotional purposes.

11. I have read and voluntarily signed the Release, Waiver, Indemnity Agreement, and Assumption of Risk.

I agree.

This event as named above includes activities involving risks or injury. I understand that activities will involve participation in exercises that are, by their nature, physically demanding and will subject the participant to stress, anxiety and possible hazards, not all of which can be foreseen. In this event the following activities will be offered.

Please check the boxes of the activities that you will allow you or your child will participate in:

1. Prayer/slain in the Spirit

2. All free time activities

3. Driving to, during, and from Kilauea Military Camp

PHOTO RELEASE: (ADULT) I hereby authorize and consent to the use of images or videos of me, with or without my name, by Kona Faith Center, Inc. of Captain Cook, Hawaii for purposes including but not limited to: promotional materials, printed publications, internet posts, including social media, television, and other media sources. I do this with full knowledge and consent and waive all claims for compensation for use or for damages. I release Kona Faith Center, Inc., its officers, directors, employees, and agents from liability for any claims by me or any third party in connection with the use of my image.

I consent to photo release (Adult)

N/A

PHOTO RELEASE: (CHILD/CHILDREN (UNDER 18)) I, the legal parent/guardian of the child/children listed below, hereby authorize and consent to the use of images or videos of my child/children listed above, with or without their names, by Kona Faith Center, Inc. of Captain Cook, Hawaii for purposes including but not limited to: promotional materials, printed publications, internet posts, including social media, television, and other media sources. I do this with full knowledge and consent and waive all claims for compensation for use or for damages. I release Kona Faith Center, Inc., its officers, directors, employees, and agents from liability for any claims by me or any third party in connection with the use of the image of my children listed below.

I consent to photo release for my child/children

N/A

I hereby acknowledge and state that my participation in this activity is entered into as a free and voluntary act with full and complete knowledge of the risks involved.

I agree.

In addition, in case of accident or need for medical attention, I give permission to Kona Faith Center, Inc. representatives to take named participant to a doctor and/or emergency facility. It is understood that all expenses for treatment provided will be borne by the parent, guardian or the participant with no cost to Kona Faith Center, Inc.

Participant Signature

Date (Participant)

Signatures of both Parents/Legal Guardians if possible:

Legal Guardian 1 Signature

Date (Legal Guardian 1)

Legal Guardian 2 Signature

Date (Legal Guardian 2)

Kona Faith Center, Inc., should be informed immediately of any change in the information presented and this agreement is valid unless revoked by the person(s) who signed it.

Men's Camp 2025

KONA FAITH CENTER, INC. ACCIDENT/INJURY RELEASE, WAIVER OF LIABILITY, INDEMNITY AGREEMENT, AND ASSUMPTION OF RISK

Name of event: Men's Camp

Date of event: Wednesday, July 23, 2025 - Saturday, July 26, 2025

Time: Wed. July 23rd, checkin by 6pm through Sat. July 26th, checkout by 9am

Location: Kilauea Military Camp