Community Workday - Waiver & Registration
Date:  Tuesday, March 31, 2026
Address: Ulupono Anahola Project at 19 Pilipoli Rd., Anahola, HI 96703 
THE GATE IS LOCATED ON THE EASTSIDE OF OUR PROPERTY - LOOK FOR THE ONE JAVA PLUM TREE ON THE PROPERTY. MARKERS WILL DIRECT YOU TO WHERE TO PARK.
Contact Kapule Torio at (808) 639-2403 if you have any questions.

Photo Release Form for Minors and Adults
The non-profit organization, Kūkulu Kumuhana O Anahola, has my permission to use my or my child's photograph publically to promote the organization. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Waiver
I, (the "Participant"), acknowledge that I have voluntarily applied to participate in the Ulupono Anahola project (the "Project"), which Project will involve site preparations for the new nursery area, weeding around our existing trees we recently planted, and preparing to put up our greenhouse.

I AM AWARE THAT SOME OF THESE ACTIVITIES ARE HAZARDOUS ACTIVITIES AND THAT I COULD BE SERIOUSLY INJURED OR EVEN KILLED. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED AND AGREE TO ASSUME ANY AND ALL RISKS ASSOCIATED THEREWITH, INCLUDING, BUT NOT LIMITED TO, BODILY INJURY, DEATH, AND PROPERTY DAMAGE, WHETHER THESE RISKS ARE KNOWN OR UNKNOWN.

In exchange for being able to take part in Project activities, the undersigned Participant hereby irrevocably and forever releases and discharges Kūkulu Kumuhana O Anahola, the County of Kauai, all owners of lands that the undersigned Participant may traverse to access the Ulupono Anahola property and their respective trustees, officers, directors, employees, agents, and representatives (collectively, the "Released Parties"), from and against all claims and demands for loss or damage, including property damage, personal injury and wrongful death, arising out of or in connection with the undersigned Participant's participation in the Project and entry on and use of the Ulupono Anahola property.

This Release and Waiver will apply only to the extent that it may provide broader protections and releases to the Released Parties. The undersigned Participant also agrees to assume full responsibility for any injury or damage to his or her own person or to other persons or property that the undersigned Participant may cause. 

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE AND WAIVER OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE RELEASED PARTIES AND SIGN IT OF MY OWN FREE WILL.

My signature will be at the end of this completed registration.

Sign in to Google to save your progress. Learn more
Participantʻs First Name *
Participantʻs Last Name *
Participants Address: Street or P. O. Box, City, County, Zip Code
Participantʻs Phone Number *
Email *
Are you Native Hawaiian? *
Are you a beneficiary or lessee of Hawaiian Home Lands?
Clear selection
Participantʻs Age *
Name of School or Group - if applicable
Name of Teacher or Coordinator - if applicable
Participantʻs Address (street, city and zip code) *
Emergency Contact (First & Last Name) *
Emergency Contact - Phone Number *
Ethnicity - Some of our grants require this information *
Please list if you have any allergies *
Signature Consent - By checking "YES", you are consenting to the use of this method in lieu of an original signature on paper.

You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use this as your signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use this as your signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

 *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of kkoa.org.

Does this form look suspicious? Report

Google Forms