Eco Rotary's Christmas Party Fundraiser 12.02.22
I, the undersigned, acknowledge that I am aware that in participating in the below-mentioned activity, that there may be risk for injury to me, but that I knowingly and with full knowledge of the possible consequences of injury waive any and all claims against the Rotary District 5000 and all individual Rotary Clubs as members of District 5000, for personal injury and/or bodily injury that I may suffer  as a result of participating in the activity. I further agree to hold harmless the Rotary District 5000 and all individual Rotary Clubs as members of District 5000 for any damages or injuries resulting from any acts or failure to act on my part during my participation in this activity. I acknowledge that I may at any time terminate this voluntary participation in the activity. I also do hereby approve the use of  pictures, videos of myself (or listed participating minor) for this activity.

I knowingly sign this waiver to induce Rotary District 5000 to permit me to voluntarily participate in the activity. This form will also act as our CONTACT TRACING FORM to meet the requirements of the City & County of Honolulu's Department of Parks and Recreation.

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I have read, understood, and agree to the D5000 waiver *
Participant First Name *
Participant Last Name *
Legal Guardian (for Minors)
Email address *
Phone Number *
Optional - Are you a Rotarian? If yes, please type yes and provide the name of your club; if no, please type no and provide the name of the person that invited you, or how you heard about the event.
Workout for a cause! Will you be joining one of our FREE Orange Theory Fitness Classes? It is optional but we do need you to sign-up as there are limited spots for each class. *
Do you want more information about EcoRotary and our upcoming events? *
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