LAC Liability, Waiver, and Registration Form 2024-2025

NOTE: Since this is the start of a new season, ALL PLAYERS must fill-out the waiver, even if they are LAC Returnees or have attended earlier training sessions

* Required

There were errors in your form submission, please fix the highlighted fields!

Player First Name

Player Last Name

Must be a valid address. A copy of the registration and signed documents will be emailed to this address

Date of Birth

Age Group

(Must be younger than the selected age group on 6/30/2024)

Team Type

Gender

Primary Phone Number

Please enter a phone that receives text messages. We would send text messages only in case of last minute cancellations or changes in time or location.

Secondary Phone Number

Residential Address

Line 1

Line 2

City

State

Zip Code

Mailing Address (if different than above)

Line 1

Line 2

City

State

Zip Code

Uniform Sizes

Jersey/Practice Shirt Size

Height

Use this format: F'I" (example 5'10")

School Information

School Attending

Grade

Graduation Year

Father/Guardian

Father/Guardian Name

Father's Home Phone

Father's Cell

Father's Work Phone

Father's Email

Mother/Guardian

Mother/Guardian Name

Mother's Home Phone

Mother's Cell

Mother's Work Phone

Mother's Email

Emergency Contact & Insurance Information

Medical Limitations

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Health Insurance Provider

Policy Number

Other Info

Years of Volleyball Experience

Position Played

Previous Club Played For

Name of Last Coach

How did you hear about LAC?

Waivers

PLEASE READ CAREFULLY - THIS AGREEMENT AFFECTS IMPORTANT LEGAL RIGHTS

Liability

I agree to the WAIVER, INDEMNIFICATION, AND RELEASE OF LIABILITY AGREEMENT

Medical

I agree to the AUTHORIZATION AND CONSENT FOR MEDICAL TREATMENT

Media

I agree to the MEDIA RELEASE AGREEMENT

WAIVER, INDEMNIFICATION, AND RELEASE OF LIABILITY AGREEMENT

You must read and sign this waiver at the bottom

In consideration of being permitted to participate in any way, including travel to and from related events and activities of the Lanikai Athletic Club (LAC), I, for myself, my personal representatives, heirs, executors, next of kin, and assigns, do hereby:

Acknowledge that I am familiar with the sport of Volleyball and understand the rules governing the sport of Volleyball and the importance of following these rules.
Agree that before participating, I will inspect the facilities and the equipment to be used, and if I believe anything is unsafe, I will immediately advise my coach or supervisor of such condition(s) and refuse to participate.
Acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, including permanent disability or death, and severe social and economic losses due to, not only my own actions, inaction or negligence, but also to the action, inaction or negligence of others; the rules of the sport of Volleyball; or conditions of the premises or any equipment used. Further, I acknowledge that there may be other risks not known to me or not reasonably foreseeable at this time.
Knowing the risks involved in the sport of Volleyball, I assume the risks and accept personal responsibility for the damages following such injury, permanent disability, or death. Further, I will not sue or make a claim against any of the released parties listed in paragraph 5 (the "releasees") and I acknowledge that the liability insurance obtained by Lanikai Athletic Club (LAC) does not provide coverage for my personal injuries or losses.
Release, waive and discharge and covenant not to sue Lanikai Athletic Club (LAC), together with their affiliated clubs, their respective administrators, directors, agents, coaches, and other employees or volunteers of the organizations; event officials; medical personnel; other participants, their parents, guardian(s), supervisors and coaches; sponsoring agencies; sponsors; advertisers; and, if applicable, owners, lessors, and lessees of premises used to conduct the event, all of whom are hereinafter referred to as "releasees", from any and all claims, demands, losses, or damages on account of injury, including permanent disability and death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise to the fullest extent permitted by Hawaii law.
Acknowledge that this waiver, indemnification and release of liability agreement ("Agreement") expressly include transportation to and from, or in connection with any activity or event of Lanikai Athletic Club (LAC) in any vehicle, including transportation to and from medical treatment.
Understand and agree that by signing this waiver, indemnification and release of liability, I am agreeing to release, indemnify the "releasees", described in paragraph 5 above, and hold them harmless from any and all liability, or costs, including but not limited to attorney fees, associated with or arising from my participation.
Understand and agree that if I am signing this Agreement on behalf of my minor child, that I will be giving up the same rights for said minor as I would be giving up if I signed this document on my own behalf. I further agree that as a parent(s) or legal guardian(s) of a minor participant under 18 years of age, that I will instruct the minor participant to the above warnings and conditions and their ramifications, and that I consent to the minor's participation.
Understand and agree that this agreement shall be governed by and construed in accordance with the Laws of the State of Hawaii and the State of Utah. All disputes and matters whatsoever arising under, in connection with, or incident to this agreement shall be litigated, if at all, in and before a court located in the State of Hawaii, U.S.A. to the exclusion of any other State or Country.
Understand and agree that this agreement may be terminated only by: Ceasing to participate in any and all activities of Lanikai Athletic Club (LAC); AND
1. Providing written notice to Lanikai Athletic Club (LAC); OR
2. Signing and returning to Lanikai Athletic Club (LAC) a later version of this Agreement.
Termination by written notice to the Lanikai Athletic Club (LAC) will not be effective until 30 days after I cease being a participant in Lanikai Athletic Club (LAC).

I have read the above waiver, indemnification, and release of liability agreement, and understand that I give up substantial rights by signing it and knowing this, sign it voluntarily. I further agree that no oral representations, statements, or inducements, apart from the above agreement have been made. I agree that this agreement is intended to be as broad and inclusive as is permitted by law and if any portion is held invalid, it is agreed that the balance shall, notwithstanding, continue to have full force and effect. I agree to participate knowing the risks and conditions involved and do so entirely upon my own free will. I also acknowledge that if English is not my first language, that I have sought out the assistance of someone competent to translate this form to me. My signature below shall be a declaration that I have so read and understand this Waiver, Indemnification, and Release of Liability Agreement. A photocopy of this Waiver will have the same effect as the original.

Parent/Guardian Signature

AUTHORIZATION AND CONSENT FOR MEDICAL TREATMENT

You must read and sign this waiver at the bottom

I/we the undersigned parent, parents or legal guardian of the above named minor, do hereby authorize in the event of an injury, accident, or illness, Lanikai Athletic Club (LAC), its coaches, team representatives, directors, officers, agents, and assignees to seek and obtain care and medical treatment as shall be necessary under the circumstances.

I/we hereby authorize and direct the above named to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care which is deemed advisable and rendered under the general or special supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medical Practice Act, of a dentist licensed under the provisions of the Dental Practice Act, and on the staff of any general hospital holding a current license to operate a hospital from the State Department of Public Health or its equivalent. This authorization is effective whether such diagnosis or treatment is rendered at the office of said physician or dentist, at a hospital, or elsewhere.

It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of my aforementioned agents to give specific consent to any and all such diagnosis which in the exercise of his or her best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned before rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached. I also agree that this authorization to treat shall be valid in any state where such treatment is rendered. I also agree that if English is not my first language that I have sought out someone to translate this form to me and agree that by my signature that I have read and understood the document.

A photocopy of this Authorization will have the effect as the original.

Parent/Guardian Signature

PERMISSION-USE OF NAME AND LIKENESS FOR PUBLICITY AND DISPLAY OF IMAGES ON THE Lanikai Athletic Club (LAC) WEBSITE AND OTHER MEDIA

You must read and sign this waiver at the bottom

By participating voluntarily, and on my own accord in the Lanikai Athletic Club (LAC), I hereby grant Lanikai Athletic Club (LAC), its agents and licensees, and other authorized media including television, radio, and newspapers, unrestricted permission to:

Use and re-use my name, photograph, voice, likeness, and biographical information including the use of such information or likeness on television and in any other media for any purpose and for use in publicity and advertising in all media.
Use, encode, digitize, copy, edit, excerpt, transmit and display on videotape, digital video stream, or any other media form, my participation;
Use and re-use my name, voice, photograph, likeness, biographic information, in connection with the Lanikai Athletic Club (LAC) Website(s);

This permission shall apply to all activities in which I participate as part of Lanikai Athletic Club (LAC) including its extended or subsequent related activities.

I/we understand that the above information will be distributed to members of the public and media to: publicize the activities of Lanikai Athletic Club (LAC) as well as the performance of individual participants; promote Lanikai Athletic Club (LAC) as an organization in the sports community; and communicate information to participants and their families the success of Lanikai Athletic Club (LAC).

I/we understand that the participants name and likeness may be included on the Lanikai Athletic Club (LAC) website and that performances may be webcast over the Internet to interested persons Lanikai Athletic Club (LAC) members of the public at large, and may be videotaped and/or digitally captured for later webcast, broadcast and/or transmission. This grant includes without limitation perpetual rights for both internal use and for licensing, sale, or other transfer of the videotapes or digital files to third parties, and includes transmission and display over the Internet. This permission is irrevocable and royalty free and I understand that Lanikai Athletic Club (LAC) will act in reliance on this permission.

I/we are the parent/legal guardian of the participant and minor listed on Page One and have the authority to make this agreement on behalf of the participant.

Parent/Guardian Signature