Entry Form
Transcription
Entry Form
Sunday, August 30, 2015 QUEENS SURF, WAIKIKI Makai of Duke Statue & Kuhio Beach ENTRY FEE: $35 Entries must be received by Friday, August 28, 2015. Maximum 1 surfing division per competitor. All entries may also enter SUP Race. Entry fee includes t-shirt, lunch and prizes. BEACH ENTRY FEE: $50 No refunds. No t-shirt for beach entries. All NSSA participants & HASA top 10 participants are not eligible to enter the contest in any division. PRESENTED BY — SPACES ARE LIMITED — CLIP & MAIL NAME OF KEIKI (Last Name) (First Name) Home Phone Mailing Address City Emergency Phone Contact (Person to Notify in Case of Emergency) Emergency Phone Number State E-Mail DIVISIONS No parental assistance in the lineup except Kokua Division Boys Shortboard: 6 - 9 years old 10 - 13 years old 6 - 9 years old 10 - 13 years old Girls Shortboard: 6 - 9 years old 10 - 13 years old Boys Longboard: 6 - 9 years old 10 - 13 years old Girls Longboard: Boys & Girls Kokua Division: 3 - 6 years old parent assist, short or long board 6 - 9 years old 10 - 13 years old Boys & Girls SUP Race: CHOOSE SHIRT SIZE: Age (as of 08.30.15): Zip S M L S M Youth Shirt Size Adult Shirt Size DOB: Returned Checks: $25.00 charge Mail Entries with Payment to: Na Kama Kai PO Box 240039 Honolulu, HI 96824 Checks made payable to: Na Kama Kai For more information: [email protected] or nakamakai.org Duke’s OceanFest – Release, Waiver of Liability, Assumption of Risk and Indemnity Agreement I acknowlege that surfing and related activities are hazardous and that I have made a voluntary choice to participate in these activities despite the risk that they present. In consideration of my being permitted to participate in the Na Kama Kai (NKK) 3rd Annual Menehune Surfing Contest/Duke’s Ocean Fest, I agree to assume any and all risks of death which might be associated with or result from my participation in the event. I understand that this waiver holds harmless the State of Hawaii, the City and County of Honolulu, Matson Navigation, Na Kama Kai, Aloha Surf Academy LLC, Outrigger Duke Kahanamoku Foundation, Duke’s OceanFest and sponsors of all the events listed as well as memebers, administrators, officials, and officers of the above mentioned parties from all/any liability for injuries and damages what so ever arising from my presence or participation in the events. I, the undersigned, have carefully read and understand this agreement and all its itmes. I understand that this release of liability which will legally prevent me or any other persons from filing suit or making any other legal claim for damages in the event of my death or any injury to me. I also agree to conduct myself in professional sportsman-like manner before, during and after, and while I am in the vicinity of all NKK/Duke’s Ocean Fest related events. I understand that any unprofessional or unsportsman-like conduct will be cuase for immediate disqualification from the event at the discretion of the Founder/CEO. PARENT’S NAME PARENT’S SIGNATURE DATE KEIKI’S NAME KEIKI’S SIGNATURE DATE