PAAC Club Officer Workshop - Registration
The Fall 2019 Club Officer Workshop (COW) will be held on Saturday, August 24 from 9:30am-1:00pm at Burns Hall (East-West Center). The event is free.

Please fill out this electronic form to register.
A Parent/Guardian signature is required to complete the form.

Although this event is meant specifically for club officers of PAAC Clubs, anybody interested in learning more is welcome to attend. Teachers/Advisors are also welcome to attend but their attendance is not mandatory.

Student Name *
Your answer
School *
Your answer
Email *
Your answer
Cell Phone
Your answer
Grade *
Officer position (if applicable)
Your answer
Have you attended previously attended a Club Officer Workshop? If yes, please specify which semester (Fall or Spring) and year
Example: Spring 2019
Your answer
Are you interested in receiving a hard copy of the PAAC Club Kit?
The Club Kit is a compilation of important information, resources, and activities. All Club Officers will be given access to the on-line version (about 200 pages total). You may also request a hard copy, which will be given to you at the workshop. Limit: one hard copy per club.
For Non-Oahu (Neighbor Island) Students Only
PAAC is able to cover the cost of airfare and transportation on Oahu for up to 2 officers per neighbor island club. Please provide the following information so PAAC can arrange your travel logistics.
Name as it appears on your ID
Your answer
Date of Birth
MM
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DD
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YYYY
Preferred airport of departure
Example: Hilo
Your answer
If you have one, provide your Hawaiian Miles number
Your answer
If you have any preferences regarding flight times or other requests, please type here. We will do our best to accommodate requests, but cannot guarantee anything.
Example: I would like my return flight to be on Sunday morning instead of Saturday afternoon so I can visit relatives on Oahu on Saturday evening.
Your answer
Student Waiver
While participating in PAAC activities, behavior consistent with PAAC’s goals and image is expected. All students are expected to follow the school rules outlined in Chapter 19 concerning student conduct and general behavior by the Hawaii State Department of Education. Failure to do so will result in your being sent home, potentially at your own expense.
Student Name *
Please type.
Your answer
Student Signature *
By typing my name below, I affirm that I am the student listed above and that I understand the above conditions and agree to abide by them.
Your answer
Date
MM
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DD
/
YYYY
Approval of Parent or Guardian and Waiver of Claims
I hereby approve the participation of my child (name listed above) in PAAC’s statewide high school program. I understand that the PAAC staff will provide information regarding each activity to my child via email, the PAAC Club advisor, After-School Class teacher in his/her school. It is the responsibility of my child to inform me of the dates and venues of these events.

I expressly waive any and all claims against the Pacific and Asian Affairs Council (PAAC) and the Department of Education (DOE), their respective board members, employees, agents, representatives and successors, arising from or in connection with any accident, injury, illness, or other damage that may be incurred by the aforementioned student or said person’s property in connection with or incident to his/her attendance at PAAC events, including travel to and from PAAC activities.

PHOTOGRAPH AND MEDIA WAIVER
I consent to allow photographs of my child participating in PAAC activities be used for publicity or grant reporting purposes (for example, on the PAAC web page or in annual reports). I understand that newspaper or television media may be present at this event. I give permission for my child to appear in the newspaper or on television.

Name of Parent/Guardian *
Your answer
Signature of Parent/Guardian *
By typing below, I affirm that I am the parent/guardian of the student listed above and I agree to the above statements.
Your answer
Date *
MM
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DD
/
YYYY
Emergency Contact Information
Name of Emergency Contact *
Your answer
Relationship of Emergency Contact to Student *
e.g. Mother
Your answer
Phone number *
Your answer
What health plan or insurance company is the student covered by?
(please also include your child's account number)
Your answer
By typing below, I hereby authorize the medical treatment of the student named above by any licensed physician in the event of a medical emergency.
Your answer
Name of Parent/Guardian *
Your answer
Signature of Parent/Guardian *
Please type.
Your answer
Date *
MM
/
DD
/
YYYY
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