Keoua Honaunau Canoe Club
P. O. Box 592, Honaunau, HI 96726
Calvin Kelekolio Long Distance Race
Saturday, August 16, 2008

Intent To ParticipateClub Name: ___________________________________________________________
Total Number Of Crews Entering: _________________________________________
Name Of Coach Or Representative: ________________________________________

CLASSIFICATION: Men Women Mixed
Koa ____ ____
Non-Koa ____ ____
Masters 40 ____ ____
Senior Masters 50 ____ ____
Kupuna 55+ ____ ____
Mixed 55+ ____

Mixed Open ____
Mixed 50+ ____
Youth Boys 18 & Under ____
Youth Girls 18 & Under ____
Mixed 18 & Under ____
The undersigned canoe club, its officers and paddlers understand that he or she may be injured as a result of participating in this canoe race, including serious injuries such as paralysis and even death, and that personal property may also be damaged. No one will be permitted to participate unless he/she freely and willingly agrees to assume all the risks of personal injury and property damage.
Each of you signing this paper, for yourselves, your heirs, assigns, and next of kin, herby release, hold harmless, and promise not to sue Moku O’ Hawaii, Keoua Honaunau Canoe Club, the State or County of Hawaii, or any of their officers, directors, or employees for any personal injuries you might receive, including death, or any damage to your property unless it results from gross negligence or intentional misconduct. You are also declaring that you believe all paddlers are in good health and do not know of any reason why they cannot participate in this event.
CANOE CLUB __________________________________
BY __________________________________ _______________________
Club Representative Telephone

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