Paint Pā'ina: "Royalty" Registration (February 14, 2022, 7:30-8:30pm) GRADES 4-12 & adult ʻohana **One application per `ohana/household.** Limited to 100 `ohana.
Please complete the following for all attendees (grades 4-12), including adult 'ohana.  Registration is limited to one per household (up to four eligible participants).  We will not be responsible for incomplete or incorrect information.  Your participation is required at our live virtual event on February 14.  Cancellation or "no show" will jeopardize your `ohana's participation in future events.  Upon completion of our online form you will receive an email confirmation.
For any questions, please email Lisa Letoto-Ohata at laletoto@hawaii.edu. Mahalo nui!
ALOHA MAI, A COUPLE OF IMPORTANT FRIENDLY REMINDERS:
Failure to attend this event will jeopardize my participation in future events.   *
As an online 'ohana enrichment event,  an adult will be present with my keiki.  I WILL NOT LEAVE THEM UNATTENDED.  (MAHALO NUI!) *
Parent/Guardian's First Name *
Parent/Guardian's Last Name *
INDEMNIFICATION: In consideration for my keiki’s participation in the Covered Program, I agree to the following on behalf of myself, my keiki, and our heirs, executors, administrators, and personal representatives:1. Representation of health. I understand the nature of the Covered Program and I represent that my keiki is in good physical, mental, and emotional health and able to participate in the Covered Program. I further agree to and represent that in connection with my keiki’s participation in the Covered Program: (a) my keiki will be covered by a private medical and liability insurance policy, (b) my keiki is not employed by the University of Hawai‘i, and (c) the University of Hawai‘i will not be responsible for or required to indemnify or defend my keiki or me with respect to any illness, personal or bodily injury, death, economic and property damage, severe emotional loss, and any other loss, damage, or injury (collectively the “Injuries/Damages”) that I or my keiki may sustain or suffer in connection with my keiki’s participation in the Covered Program.2. Assumption of risk. I understand and acknowledge the dangers and risks involved in my keiki’s participation in the Covered Program including the Injuries/Damages. These Injuries/Damages may be caused by the actions or inactions of my keiki or others participating in the Covered Program, and/or the conditions where the Covered Program occurs. I acknowledge that there may be other Injuries/Damages not known to me or not readily foreseeable at this time. I hereby fully accept and assume all risks of the Injuries/Damages resulting from my keiki’s participation in the Covered Program. I have read and understood all written materials setting forth the requirements for my keiki’s participation and I have instructed my keiki to observe, follow, and comply with all verbal and written instructions.3. Waiver and release. I hereby waive, release, and discharge any and all claims, demands, actions, rights, and causes of action for any and all Injuries/Damages, known or unknown, related to, arising from, or traceable either directly or indirectly to my keiki’s participation in the Covered Program (collectively the “Released Claims”).4. Indemnify, defend, and hold harmless. I accept full responsibility for my keiki’s participation in the Covered Program and I agree to indemnify, defend, and hold harmless the University of Hawai‘i, and its past, present and future Board of Regents, officers, employees, agents, and assigns from any and all Released Claims and any and all demands, actions, judgments, injunctions, orders, directives, penalties, assessments, liens, liabilities, losses, damages, costs, and expenses (including attorneys’ fees), arising or resulting from or caused by any acts or omissions by my keiki or myself (or by any person for whom I am responsible) during, involving, or related to my keiki’s participation in the Covered Program.5. Photo, Video and Sound Recording Release and Consent. I authorize the University of Hawai‘i and its officers, agents, employees, successors, licensees, and assigns to take and use photographs, video, and sound recordings of and/or live stream my keiki’s participation in the Covered Program, and to use my keiki’s name, image, likeness, appearance, and voice (collectively the “Recordings”): (a) for any legitimate purpose, including any educational, institutional, scientific, fundraising or informational purposes whatsoever, (b) in perpetuity, (c) on a worldwide basis, (d) without compensation to my keiki or me, (e) in any manner or media, including use on social media sites and web pages accessible to the general public, and (f) alone or in combination with other Recordings. All right, title, and interest in the Recordings belong solely to the University of Hawai‘i. I understand the Covered Program may attract media coverage or be recorded, in whole or in part, for rebroadcast or retransmission, and I consent to my keiki’s inclusion in such media coverage, which may appear in print media, live or replay telecast or broadcast, podcast, and/or through social media and internet postings.APPENDIX 7AUHOGC Revised 9/26/18I have read this Parent/Legal Guardian Consent, Waiver, Release, and Indemnity (“Agreement”) and I understand that my keiki and I are giving up substantial rights, including the right to sue. I acknowledge that my keiki is participating in the Covered Program freely and voluntarily. I agree that: (a) the laws of the State of Hawai‘i shall apply to this Agreement and (b) if any portion of the Agreement is deemed or held invalid, the remainder of the Agreement shall continue in full force and effect. *
At least one of my keiki attends a HI DOE or Charter School (check one for keiki listed on registration):
USPS Mailing Address *
City *
State *
Zip Code *
Phone Number *
Number of PAINTING PARTICIPANTS (*Limit to 4) *
This is my `ohana's first time participating in Paint Pa`ina: *
Required
Ethnicity of Child(ren) *
Name of Participant #1 (Last, First) *
Child #1 School *
Grade of Child #1 *
Name of Participant #2 (Last, First)
Child #2 School (Type NONE if you are a parent/adult)
Grade of Participant #2
Name of Participant #3 (Last, First)
Child #3 School (Type NONE if you are a parent/adult)
Grade of Participant #3
Name of Participant #4 (Last, First)
Child #4 School (Type NONE if you are a parent/adult)
Grade of Participant #4
I have checked all the information entered and acknowledge that it is accurate.  This includes my email address, mailing address, `ohana names, and keiki information.  I understand that Na Pua No`eau is not responsible for incorrect or incomplete information that I entered, and it may affect my participation in the program or event.   *
ALOHA MAI, A COUPLE OF IMPORTANT FRIENDLY REMINDERS: If you are registering for our event, we ask for your commitment to attending!  Failure to participate may jeopardize your participation in future events.  This is an ʻohana online enrichment event so please make sure an adult is present with your keiki.  PLEASE DO NOT LEAVE THEM UNATTENDED.  MAHALO NUI!
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of University of Hawaii.