HAWAI`I CONFERENCE FOUNDATION

1848 Nu’uanu Avenue * Honolulu, Hawaii 96817 * (808) 791-5638 * FAX (808) 521-7196

STATEMENT INDEMNIFYING AGAINST LIABILITY CLAIM

Designated Site: Waineke Cabins, Kokee

Date(s): Time(s): M.

The undersigned individual(s), group and/or organization, and his, its or their heirs, personal representatives, successors and permitted assigns, for and in consideration of the Hawaii Conference Foundation (“HCF”) permitting and allowing the use of the above designated site jointly and severally agree(s) to indemnify, defend and hold forever harmless the Hawaii Conference United Church of Christ and the Hawaii Conference Foundation and their Directors, Trustees, employees and agents (collectively also “HCF”) against any and all loss, liability, demands, claims, suds, actions or proceedings of every name, character and description (including but not limited to attorneys' fees and costs) which may be suffered or incurred by or brought against HCF for or on account of any injuries, wrongful death or damages to any person(s) or property arising directly or indirectly, by or in consequence of the use of or any activity conducted with the designated equipment or any other HCF equipment by the undersigned individual(s), groups and/or organization. The undersigned hereby certifies that prior to signing below it has carefully inspected the site designated above and accepts the same "as is."

The undersigned further assumes all risk of injury arising out of any condition with the designated site, or in or on any other HCF facility, whether such condition is latent or apparent, and waives any and all claims against HCF for any injury to person or property which may be sustained by the under‑signed as a result of the undersigned's use of the designated site or any other HCF facility. The undersigned understands and acknowledges that HCF makes no representation or assurance that the designated site or any other HCF facility is safe or fit for the undersigned's intended use, and the undersigned agrees that the undersigned will be solely responsible for making all appropriate arrangements to ensure that the designated site or other HCF facility is safe and fit for the undersigned's intended use.

Any and all physical damage to HCF facilities and/or property arising directly or indirectly out of the undersigned's use of the facility shall be repaired and/or replaced by the undersigned within ten days from the event date. In the event that the undersigned fails to satisfactorily repair and/or replace the damage within such period, HCF, without waiving any rights, may undertake to repair and/or replace such damage, and the undersigned agrees to reimburse and shall reimburse HCF for all actual costs incurred plus an administrative cost of 10% of the actual costs, within five days after receipt of the bill.

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Signature and Date

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