Ikaika Mandatory Photo Release Waiver and Covid 19 Survey
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IKAIKA coaches and staff regularly photograph children in our Watermans activities for use in promotional material either in print or on Ikaika social media and the website. It is Ikaika's policy not to directly associate a child's name with a photograph of the child. I give permission for IKAIKA personnel to use the said child's photo for these purposes.
Please print name and date.


 

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COACH SHELLEY OATES LLC, IKAIKA HAWAII WATERMANS ACADEMY & HAWAII YACHT CLUB  WAIVER AND RELEASE OF LIABILITY READ BEFORE SIGNING
IN CONSIDERATION of being permitted to participate in anyway in any programs facilitated by Coach Shelley Oates LLC and/or Ikaika Hawaii Watermans, Hawaii Yacht Club and any related activities (collectively "Activities") ; I, for myself ,my personal representatives, assigns, heirs, and next of kin: 
 I ACKNOWLEDGE, agree, and represent that I understand the nature of Waterman's Activities, paddling and any related activities and hereby warrant that I am qualified, in good health, and in proper physical condition to participate in such Activities and willingly agree to comply with the Standards, Rules and customary terms and conditions of participation in the Activities.
 
 I FULLY UNDERSTAND that: (a) Shelley Oates-Wilding LLC, IKAIKA Hawaii Watermans Program Activities, Hawaii Yacht Club and any related activities INVOLVE RISKS AND INHERENT DANGERS OF HARM TO PERSON AND SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH as well as PERSONAL PROPERTY DAMAGE AND LOSS (collectively"Risks") (b) exposure to these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in, coaching, assisting or watching such Activities, the weather, wind, sea, current or other conditions in which the Activities take place, or THE NEGLIGENCE OF THE RELEASEES" NAMED BELOW and( c ) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ANY AND ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES that I incur as a result of my participation or the participation of the Minor (entered and described below) in such Activities.

I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE Shelley Oates-Wilding LLC, Ikaika Hawaii Watermans, Hawaii Yacht Club and their affiliated clubs, their respective coaches, assistants, administrators, directors, agents, officers, members, volunteers, and employees, other participants, any donors, sponsors, advertisers, and, owners and lessors of premises on or from which the Activities commenced or take place, (each of which is considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, PERSONAL INJURIES, DAMAGE TO PROPERTY, OR OTHER DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if , despite this RELEASE
 
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)
AND I, THE MINOR'S PARENT / LEGAL GUARDIAN, AFFIRM THAT I HAVE READ AND AGREE ON BEHALF OF THE MINOR PARTICIPANT TO ALL PROVISIONS STATED ABOVE AND UNDERSTAND THE NATURE OF PROGRAMS FACILITATED BY COACH SHELLEY OATES LLC, IKAIKA HAWAII WATERMANS AND HAWAII YACHT CLUB , AND ACTIVITIES AND KNOW THE MINOR'S EXPERIENCE AND CAPABILITIES AND WARRANT THAT THE MINOR IS QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITIES. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE'S FROM ALL LIABILITY, DEMANDS, LOSSES OR CLAIMS AGAINST "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR'S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS, LIABILITY, DAMAGE, OR COST WHICH MAY INCUR AS THE RESULT OF SUCH CLAIM.

PLEASE PRINTED NAME OF PARENT/GUARDIAN AND DATE IN THE FIELD BELOW
 

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COVID- 19 SURVEY 
The safety of our participants and families is our overriding priority. As the coronavirus (COVID-19) pandemic continues, we are monitoring the situation closely and following the guidance from the Centers for Disease Control and Prevention and local health authorities. In order to prevent the spread of the coronavirus and reduce the potential risk of exposure to our workforce, we are asking everyone to complete and submit this questionnaire prior to the academy. Please do not attend until your responses have been reviewed and your entry has been approved.
Please respond to each of the following questions truthfully and to the best of your ability. Your participation is important to help us take precautionary measures to protect you and our families. 
 
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Are you or anyone in your family currently experiencing, or have you experienced in the past 14 days, any of the following symptoms? (
Please take your temperature and the participants temperature before answering these questions.)
Fever (100.4° F/37.8° C or greater as measured by an oral thermometer)
Cough
Shortness of breath or difficulty breathing
New loss of taste or smell
Sore throat
Head or muscle aches
NONE OF THE ABOVE
Other  
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Are you or anyone in your family currently experiencing, or have you experienced in the past 14 days, any of the following symptoms??(Please take your temperature and the participants temperature before answering these questions.)
YES
NO
Other  
  • Comment:

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In the past 14 days, have you been in close proximity to anyone who has tested positive for COVID-19?
YES
NO
Other  
  • Comment:

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Have you been tested for COVID-19 and are waiting to receive test results?
YES
NO
Other  
  • Comment:

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Have you have tested positive for COVID-19, or are you presumptively positive for COVID-19 based on your health care provider's assessment or your symptoms?
NOTE: If you have tested positive for COVID-19 or have been presumptively positive for COVID-19 based on your health care provider's assessment or your symptoms, please contact your manager or human resources representative when: (1) you have had no fever for at least 72 hours (3 full days), without the use of fever-reducing medications; (2) your other symptoms have improved; and at least 7 days have elapsed since your symptoms first appeared.
YES
NO
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In the past 14 days, have you OR anyone in your family been on a commercial flight or traveled outside of the United States?
YES
NO
Other  
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In the past 14 days, have you been in close proximity to anyone who has been on a commercial flight or traveled outside of the United States?

YES
NO
Other  
  • Comment:

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Is there any reason why you feel you are at higher risk of contracting COVID-19 or experiencing complications from COVID-19 by entering the facility? If "yes", please provide a brief explanation.

YES
NO
OTHER
Other  
  • Comment:

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PLEASE INDICATE IF YOU ARE AN ESSENTIAL WORKER
NOTE: Please add explanation to the comments.
 

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I hereby certify that the responses provided above are true and accurate to the best of my knowledge.
Please sign/ type your name.
Note: The information collected on this form will be used to determine only whether you may be infected with COVID-19. The information on this form will be maintained as confidential. Any questions should be directed to the program director. shelley@ikaikahawaii.com
 

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