Eco Rotary's Pearl Haven Service Project Waiver Form 10.29.22
I, the undersigned, acknowledge that I am aware that in participating in the below-mentioned volunteer community service project, that there may be risk for injury to me, but that I knowingly and with full knowledge of the possible consequences of injury waive any and all claims  against the Rotary District 5000 and all individual Rotary Clubs as members of District 5000, for personal injury and/or bodily injury that I may suffer  as a result of participating in the service project. I further agree to hold harmless the Rotary District 5000 and all individual Rotary Clubs as  members of District 5000 for any damages or injuries resulting from any acts or failure to act on my part during my participation in this service  project. I acknowledge that I may at any time terminate this voluntary participation in the service project. I also do hereby approve the use of  pictures, videos of myself (or listed participating minor) for this service project.

I knowingly sign this waiver to induce Rotary District 5000 to permit me to voluntarily participate in the service project. This form will also act as our CONTACT TRACING FORM to meet the requirements of the City & County of Honolulu's Department of Parks and Recreation.

DIRECTIONS:

Pearl Haven is located on the North Shore closer to Turtle Bay side. ADDRESS: 58-130 Kamehameha Hwy, Haleiwa. Please use their secondary gate entry. If coming from Kahuku it is 50 yards BEFORE the main gate mountain side, turn left into the gravel driveway and park in the big open field. If coming from Haleiwa, it is 50 yards AFTER the main gate mountain side, turn right into the gravel driveway and park in the open fi  


ITEMS TO BRING:
*WATER BOTTLE
*COVERED SHOES
*HAT
*SUNSCREEN
*GLOVES
*SNACKS

ADDITIONAL ITEMS:
*WEED WHACKERS
*CHAIN SAWS
*HAND TOOLS: CLIPPERS, LOPPERS, ETC.
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I have read, understood, and agree to the D5000 waiver, and: *
Participant First Name *
Participant Last Name *
Legal Guardian (for Minors)
Email address *
Phone Number *
Optional - Are you a Rotarian? If yes, please type yes and provide the name of your club; if no, please type no and provide the name of the person that invited you, or how you heard about the event. *
Do you want to learn about Eco Rotary Club of Kaka'ako's future service projects & events? *
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