the registration form

Hawaii National Guard
presents
Barefoot League
5TH ANNUAL
Field of Legends Football Clinic
Hawaiian Airlines Field at Aloha Stadium
Saturday, February 8, 2014
Clinic conducted by Current and Former NFL and College Players
Instructors include: Brian Te’o, Roby Toma, , Chad Owens(Toronto Argonauts),
Samson Satele (Indianapolis Colts), Colt Brennan, Bryant Moniz, Vince Manuwai, Maa Tanuvasa,
Chris Fuamatu-Maafala, Leonard Peters, Nate Jackson, Laanui Correa, Eddie Klaneski, David Maeva,
Houston Ala, Ed Ripley, Mika Liilii, Nalei Cox, Tupu Alualu, Silila Malepeai, Anthony Arcenaux,
Afatia Thompson, Gerald Welch and other Special Guests.
Date:
Clinic Location:
Time:
Saturday, February 8, 2014
Aloha Stadium (entrance: Gate 4 South End Zone)
$85 Ages 7-12:
5:30pm - 7:30pm (Check in 4:30pm)
$85 Ages 13-18:
8pm - 10pm (Check in 7:00pm)*
*(Opportunity to play under the bright lights of Aloha Stadium)
$95 Late Entry
Clinic Includes: T-shirt, snack, drinks, gift bag
Clinic Registration: Wednesday, January 17th - Wednesday, February 5th, 2014
Late & walk in registration will be accepted on space availability only
Download at: www.facebook.com/BarefootLeague (must fill out all forms)
Mail to: Barefoot League, LLC
2754 Kuilei St. #904
Honolulu, HI 96826
Payment:
Credit cards accepted at the www.Barefootleague.com
all returned checks will have a fee of $30.00
Maximum 300 participants per session
Download at: www.facebook.com/BarefootLeague
For more information, email: [email protected] or call 808.734.0200
MC Group Hawaii, Inc.
Certified Public Accountants
Barefoot League LLC
Waiver of Liability, Assumption of Risk, and Indemnity Agreement
Waiver of Liability, Assumption of Risk, and Indemnity Agreement Waiver: In
consideration of being permitted to participate in any way in the Barefoot League Field
of Legends Football Clinic hereinafter called "The Activity", I, for myself, my heirs,
personal representatives or assigns, do hereby release, waive, discharge, and
covenant not to sue Barefoot League LLC, including but not limited to its officers,
employees, and agents from liability from any and all claims including the
negligence of Barefoot League LLC, its officers, employees and agents, resulting
in personal injury, accidents or illnesses (including death), and property loss arising
from, but not limited to, participation in The Activity
Assumption of Risks: Participation in The Activity carries with it certain inherent risks
that cannot be eliminated regardless of the care taken to avoid injuries. The specific
risks vary from one activity to another, but the risks range from 1) minor injuries such as
scratches, bruises, and sprains, 2) major injuries such as eye injury or loss of sight, joint
or back injuries, heart attacks, and concussions to, 3) catastrophic injuries including
paralysis and death.
I have read the previous paragraphs and I know, understand, and appreciate
these and other risks that are inherent in The Activity. I hereby assert that my
participation is voluntary and that I knowingly assume all such risks.
Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD Barefoot
League LLC HARMLESS from any and all claims, actions, suits, procedures, costs,
expenses, damages and liabilities, including attorney’s fees brought as a result of my
involvement in The Activity and to reimburse them for any such expenses incurred.
Severability: I further expressly agree that the foregoing waiver and assumption of
risks agreement is intended to be as broad and inclusive as is permitted by the law of
the State of Hawaii and that if any portion thereof is held invalid, it is agreed that the
balance shall, notwithstanding, continue in full legal force and effect.
By signing the Medical Clearance Form, I state that I have read this waiver of liability,
assumption of risk, and indemnity agreement, fully understand its terms, and
understand that I am giving up substantial rights, including my right to sue. I
acknowledge that I am signing the agreement freely and voluntarily, and intend by my
signature to be a complete and unconditional release of all liability to the greatest
extent allowed by law.
Permission for media use: I agree to give permission to use audio/video/photos of my
child for media purposes.
BAREFOOT LEAGUE
FIELD OF LEGENDS FOOTBALL CLINIC
REGISTRATION / MEDICAL CLEARANCE FORM
Participant’s Name: __________________________________ Date of Birth: ____/____/_____ Age: _____
Address: _____________________________________ City: _____________ State: _____ Zip: _________
Email: _________________________________________
Gender:
male
female
Emergency Name: _____________________________________ Relationship: _______________________
Contact # 1 Cell Phone: ________________________________ Other Phone: ________________________
Emergency Name: ______________________________________ Relationship: ______________________
Contact #2 Cell Phone: ______________________________ Other Phone: ___________________________
Allergies (please list): _____________________________________________________________________
Operations or Serious Injuries: _____________________________________________________________
Disabilities or Chronic Illness: _____________________________________________________________
Dietary Issues: __________________________________________________________________________
Current Medications: _____________________________________________________________________
Physician Name: ________________________________ Phone: __________________________________
_____ $85 Ages 7-12:
5:30pm - 7:30pm (Check in 4:30pm)
_____ $85 Ages 13-18:
8pm - 10pm (Check in 7:00pm)*
*(Opportunity to play under the bright lights of Aloha Stadium)
_____ $95 Late Entry
Participant’s T-Shirt Size: Youth ( ) Med ( ) Lg
Adult ( ) Sm ( ) Med ( ) Lg ( ) XL ( ) 2XL ( ) 3XL
PARENT AUTHORIZATION: I certify that the individual named above is in good physical condition and is capable of
taking part in all clinic activities. I am aware that football is a physically demanding sport that requires strenuous effort. I
am not aware of any medical or physical condition(s) that would limit his/her participation in the BAREFOOT LEAGUE
FIELD OF LEGENDS FOOTBALL CLINIC. If medical attention beyond first-aid treatment is required, I understand that
every attempt will be made to contact me at the emergency number provided. If contact with me is not possible, I give
permission for emergency transport and medical attention to be administered.
By signing below, I also hereby acknowledge and accept the Barefoot League LLC Waiver of Liability, Assumption of
Risk, Indemnity Agreement & Permission for Media use
Signature of Parent/Guardian of Minor
Date
Signature of Participant
Date
*Please mail this form along with your Media Waiver form and payment to: Barefoot League LLC
2754 Kuilei St. #904
Honolulu, HI 96826
I, _________________________, with no expectation of monetary or material
compensation, hereby RELEASE and WAIVE
by BAREFOOT LEAGUE
and it’s authorized designee of my likeness,
and/or my voice on film, videotape, or sound recording, in any commercial, promotion,
news program, documentary, educational film, feature film, and/or other program or
picture, including still photos, which may be exhibited or broadcast on television, radio,
CATV, or reproduced in print media, by means of video cassette recorders, or in motion
picture theaters, schools, or other educational institutions or publications.
___________________________
Signature
____________
Date
(If under 18 years of age, complete the following)
I, _____________________________, parent of __________________________,
do hereby give my unqualified consent and agreement to the terms of the foregoing
RELEASE and WAIVER..
____________________________
Parent’s Signature
____________
Date