Lokahi Winter Tennis Camp 2025 Form

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Lokahi Tennis during the selected camp. In exchange for the acceptance of said child’s candidacy by Lokahi Tennis., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Lokahi Tennis. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Lokahi Tennis. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Lokahi Tennis. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Yes, I, myself, or a parent/legal guardian of the minor named, by signing this form, grant permission to Lokahi Tennis to use photographs or videos of myself or my child or his/her work in education, outreach, or advertisement media published or authorized by the organization for the life of the photo/video. I understand the term work can include both visual arts and written pieces. I understand the term media can include Lokahi Tennis' partner organization websites, social media, publications, newsletters, videos, presentations, marketing material, newspaper and magazine articles, and television and film clips.

Waiver of Responsibility

Acceptance of my entry in this program is without assumption of responsibility of any kind by Lokahi Tennis and  the Department of Parks and Recreation. In consideration of my entry, I do hereby for and on behalf of myself and my heirs and legal representatives release and forever discharge Lokahi Tennis, all organizers of this program and the Department of Parks and Recreation from any and all claims and demands of every kind, nature and character excepting gross negligence, reckless conduct, or willful, wanton conduct, which I may have or may hereafter acquire  for any and all damages, losses or injuries which may be suffered or sustained by me in connection with my  activities during the period for which such permission is granted and any period traveling to or from such event  described, and all such claims are hereby waived and released and I covenant not to sue therefore.

Student COVID-19 Self-Certification and Verification Form

Because of the Covid-19 pandemic, some prevention strategies are implemented to ensure a safe and healthy environment in Lokahi Tennis (the "Organization"). These implementations include a daily symptom screening for each student prior to participating in any Lokahi-organized events.

A Lokahi-organized event includes, but is not limited to: 

• Practices
• Matches
• Play days
• Clinics
• Tournaments

Parents/Guardians must conduct this daily symptom screening prior to their athlete departing for Lokahi-organized events and report consistent with the parameters outlined below. This form must be signed and returned to Lokahi Tennis prior to the start of the enrolled program.

COVID-19 symptoms for screening: 

• Fever (100.4 or higher) 
• New* cough 
• Shortness of breath/difficulty breathing 
• Fatigue from unknown cause 
• Muscle or body aches from unknown cause 
• New* onset of moderate to severe headache 
• Sore throat 
• Congestion/runny nose 
• New* loss of sense of taste or smell 
• Nausea or vomiting 
• Diarrhea 
• Any other COVID-19 symptoms

*According to the IDPH, the reference to “new” means, new onset of a symptom not attributed to allergies or a pre-existing condition.

 

I, undersigned, agree with the following statements. 

• I am the parent/guardian of the athlete indicated above.
• I verify that prior to attending a Lokahi-organized event, my athlete will receive a daily symptom screening at home by an adult caregiver to determine if my athlete is experiencing any COVID-19 symptoms.
• By sending my athlete to a Lokahi-organized event on any given day, I am certifying and verifying that my athlete has received a daily symptom screening at home and is not experiencing any COVID-19 symptoms listed above.
• If my athlete is experiencing any of the above symptoms at the time of the daily screening, I will notify the coach of my athlete's absence by sending an email and/or text message and indicating the above symptoms that my athlete is experiencing.
• If a Lokahi member contacts me to gather additional information related to the results of my athlete's daily screening, I will provide the necessary information as requested.
• By sending my athlete to a Lokahi-organized event on any given day, I am also certifying and verifying that my athlete is not subject to an isolation or quarantine protocol related to COVID-19.
• I will also notify the coach if my athlete receives a diagnosis of COVID-19, my athlete is suspected of having COVID-19, my athlete comes in close contact with an individual who tested positive for COVID-19 or is suspected of having COVID-19, or my athlete traveled internationally.
• I understand that my athlete will not be allowed to participate in in-person instruction until this form has been completed and submitted.
• I am fully and personally responsible for my own and my athlete's safety and actions while and during his/her participation and I recognize that we may be in any case be at risk of contracting COVID-19.
• With full knowledge of the risks involved, I hereby release, waive, discharge the Organization, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.
• I agree to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.