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ASSUMPTIONS OF RISK AND RELEASE I, the undersigned, in full recognition and appreciation of the dangers and hazards inherent

in the activity as described in more detail on the reverse, and during the transportation to and from the activity site(s) to which I may be exposed during my enrolment and/or participation, do hereby agree to assume all the risks and responsibilities surrounding my participation, or any independent research or activities undertaken as an adjunct thereto; and further, I do for myself, my heirs, executors, and administrators hereby defend, hold harmless, indemnify, and release, and forever discharge the University and all its offices, agents and employees from and against any and all claims, demands, and actions, or causes of action, on account of damage to personal property, or personal injury, or death which may result from my participation, and which result from causes beyond the control of, and without the fault or negligence of the University, its officers, agents or employees, during the period of my participation as foresaid. IN WITNESS WHEREOF, I have caused this release to be executed and in full cognizance of these hazards, I hereby assume full responsibility for my actions, for all risk, and for the result of my choices during this activity. In the event of an emergency, my signature(s) permits the Employment Training Center to contact my physician. STUDENT VOLUNTARY DISCLOSURE STATEMENT It is the policy of the University of Hawaii to provide equal opportunity in higher education, both in the educational mission and as an employer. All qualified persons, especially women, members of minority groups, persons with disabilities and Vietnam Era veterans, are encouraged to apply. Those students wishing to provide appropriate information regarding their handicapping condition or other special work place accommodation requirements may do so on a VOLUNTARY basis. All information submitted will be kept confidential and students who elect to submit such information SHALL NOT suffer any adverse treatment or consideration. I decline to disclose or No disclosure necessary I, the undersigned, realize that it is in my best interest to disclose the following information, which is relevant to the tasks I will be assigned in participating in this activity, as described in more detail on the reverse. I understand that may information disclosed will be treated confidentially. I further attest that I have been informed of the activities we will undertake and the conditions of those activities. __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ ♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦ I have read and understand the Assumption of Risk, and the Student voluntary Disclosure Statement. In full cognizance of these hazards, I hereby assume full responsibility for my actions, for my risks, and for the results of my choices. And if I desire, I will inform (via Student Voluntary Disclosure Statement) my instructor of any conditions that is relevant to the task I will be assigned in participating in this activity. I choose not to participate in this activity I would like to participate in this activity ___________________________________________
Student Signature Date

Parent/Guardian Signature (High School Student Only) Date

________________________________________________ Student Name (Print) Date

______________________________________________________ Parent/Guardian Name (Print) Date

My physician’s name is: __________________________________________________________________________________________________ My medical insurance is: __________________________________________________________________________ _______________________