MLEF Mandatory Health and Liability Waiver
E komo mai (Welcome) to Loko ea Fishpond.

In the interest of everyone’s safety during the coronavirus pandemic, please read and sign this risk agreement within 72 hours of participating in the Activities with Mālama Loko Ea Foundation. Nīnau (questions) may be directed to info@lokoea.org. We may need to contact you regarding your answers before confirming your visit.

Please complete one per person.

We look forward to seeing you! Mahalo!
Email Address *
Date of Visit *
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Type of Visit *
Last Name *
First Name *
Middle Initial
Gender *
Zip Code: *
Participant Date of Birth *
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Are you of Native Hawaiian ancestry? *
Contact mobile phone **In case we need to contact you *
Do you or anyone in your household have any of the following? Fever, shortness of breath, cough *
Required
Have you or anyone in your household had any cold or flu-like symptoms, such as fever, cough or shortness of breath, within the last 14 days? *
I certify that in the last 14 days: I have not been in close contact with anyone with COVID-19 Symptoms; and I have not been in contact with anyone who has tested positive for the Covid-19 Virus. *
Have you or anyone in your party traveled outside of the State of Hawai‘i in the past 14 days *
Clear selection
I certify that I will have current and active health insurance during the term of the Activities, and I will provide, if asked, proof of said insurance to the Mālama Loko Ea Foundation (MLEF) prior to beginning the Activities. I acknowledge that by working with other participants and MLEF staff, I may be exposed to COVID-19 or other illnesses during the term of my Activities. I acknowledge that I should not be participating in the Activities if I am age 65 or older or, at any age, have a serious underlying medical condition as identified by the Centers for Disease Control (CDC) as I might be at higher risk for severe illness from COVID-19. I acknowledge and agree that MLEF makes no representation or warranty that I will be fully protected from exposure to COVID-19 when participating in the Activities and assume all risk associated with my participation. I am typing my name below to serve as an electronic signature for all names listed above and acknowledge that I have addressed the terms of this waiver with said participants. *
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