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County of Kauai

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4444 Rice St, Lihue, HI, 96766, US

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NOT ACCEPTING REGISTRATIONS AT THIS TIME Kauai Police Activities League 2020 BOXING

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Participants School

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Additional Parent Contact

Does/Did your child have any of the following conditions: Fainting Spells, Headaches, Convulsions/Epilepsy, High Blood Pressure, Kidney Problems, Intestinal Disorders, Hernia, Heart Disorders , Other?

Does/Did your child have any of the following conditions: Dental Plate, Poor Vision, Poor Hearing, Asthma or Other?

Does/Did your child have any injuries to the following: Toes, Feet, Ankles, Knees, Thighs, Hips, Lower Back, Upper Back, Ribs, Abdomen, Chest, Neck, Fingers, Hands, Wrist, Forearms, Elbows, Upper Arms, Shoulders, Head?

Is your child currently taking any medication?

Does your child have any adverse reactions to any medications?

Does your child have any existing and/or past medical or emotional condition(s) that require special concern & attention by a coach?

Media Consent-I understand that during a Kaua'i Police Activities League (K-PAL) program or event, my child and I may have their photograph taken by a member of K-PAL or other media entities. I agree that my child and I may be photographed, including video & film photography, and any other reproduction of our likeness, which may be used without charge by K-PAL for any purpose deemed appropriate, including but not limited to promotional materials, fundraising, presentations or proposals, newspaper, or magazine publications or posting on a website for promotional purposes.If you would not like your child to be photographed, please contact K-PAL at kpal@kauai.gov or 241-1647

Release of Indemnity - A. That there is a substantial value and benefit to be derived by MINOR in participating in any and all sports and recreational activities from January 1, 2020 to December 31, 2020, which is being sponsored by Kauai-PAL. B. In the event that as the alleged result of consequence or negligence on the part of anyone, that they shall forever release and waive any and all rights to bring suit or claims against, and will indemnify and hold harmless, the County of Kauai, it’s officers, agents and employees, Kauai-PAL Program & it’s Board Of Directors, the Kauai Police Department, or any representative, sponsor, manager, coach, trainer, or person who is in any manner connected with the operations of the Kauai-PAL Program, on account of any and all claims, demands, loss of services, or expenses for property damage, and/or personal injuries, that may arise as a result of said minor’s participation in, or transportation to and from the subject Kauai-PAL activity. C. That COUNTY is not to be liable for death or injuries resulting during period when MINOR is transported to ACTIVITY. D. To give consent to allow MINOR to actively participate in ACTIVITY. E. That PARENT(S) recognizes and understands that participation in ACTIVITY involves risk or death, personal injury, and/or property damages, commonly inherent in such activity. F. That MINOR, through PARENT or LEGAL GUARDIAN, voluntarily chooses to participate in ACTIVITY, to which action PARENT or LEGAL GUARDIAN, gives approval and consent. G. That said MINOR is in reasonable good physical and mental health, such that MINOR can safely participate in ACTIVITY. H. To notify a representative from the Kauai-PAL PROGRAM if there is any change in MINOR’S physical and/or mental condition such that MINOR cannot safely participate in ACTIVITY. I. I/we the parents/guardians of the said MINOR acknowledge that, although highly unlikely, a participant may be exposed to serious injury or death. I/we solely assume the risk involved and grant approval for my/our child to participate in the Kauai-PAL’s Program. I/we agree not to hold said organization, its officers, coaches, volunteers, sponsors of teams or any other patron or benefactors of this liable for any injury, or death resulting from injury, to my/our child while participating in said program. If my/our child is injured while participating, I hereby grant permission for his/her admittance to any medical facility deemed appropriate for treatment. Before my/our child participates in physical fitness practice, I/we agree to furnish proof of his/her age, and all required forms. Permission is granted for the league (Kauai-PAL) to validate his/her grades. I/we certify that to the best of my/our knowledge, all information provided is correct.

Parent Guidlines - 1. Teach the ideals of good sportsmanship and fair play by setting an example for your child and other participants. Your demeanor at practice and scheduled events or activities is a big factor to achieve these ideals. 2. Controversies will arise and tough decisions must be made. The Kauai-PAL coach(s), Kauai-PAL supervisor and his/her staff will make those decisions in the best interest of the program. Your understanding, tolerance and acceptance are requested. Your patience is greatly appreciated in this program. 3. No interference with the coaching staff during practices and scheduled events. Any coaching or personal corrections should be done on your own time. 4. Any questions or doubts should be brought to the attention of the Head Coach(s). Should the problem remain unsolved, a parent meeting will be scheduled, which shall include the Coach(s) and his/her staff and the Kauai-PAL staff in charge. 5. Keep in mind always that Kauai-PAL exists solely for our youth. Therefore, decisions made by the Kauai-PAL staff, supervisors and trainers will be made in the best interest of the boys and girls in the program. 6. Remembering that the program is for the boys and girls of our communities and should be about them and not about any adult’s personal agenda. Decisions will be based upon those ideals. I understand that if i do not agree or understand, i will contact K-PAL at kpal@kauai.gov or 241-1647.

You understand the K-PAL has provided concussion information on its website (www.kauaipal.org) under the heading 'Concussion'. For the safety of your child, please review the information provided. You can copy and paste the direct link below or head to www.kauaipal.org. https://tshq.bluesombrero.com/Default.aspx?tabid=2581017. I understand that if i do not agree or understand, i will contact K-PAL at kpal@kauai.gov or 241-1647.

Please attach Meal Eligibility Form (Free or Reduced lunch) if you are interested in a registration fee waiver. If unable to attach form, please email to kpal@kauai.gov. PLEASE DO NOT COMPLETE PAYMENT IF INTERESTED IN WAIVER

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Please do not submit registration until you are ready to make payment or attached your meal eligibility form. You will be directed to a PayPal site to complete payment. Those interested in a registration waiver must not complete payment. Please contact kpal@kauai.gov or 241-1647 if you have any questions