Oahu Club Aquatic Program – Registration Application

Kamahamaha Swim Club/Hawaii Kai

Swimmer’s name:

Age:

Birth Date:

Address:

City:

State:

Zip:

Email Address:

Any previous Team Experience?

Team Name:

Mother’s Name:

Phone (H):

Phone (W):

Father’s Name:

Phone (H):

Phone (W):

Oahu Club Member: Y [ ] N [ ]

Notify in emergency:

Phone (H):

Phone (W):

Doctor:

Phone:

Medical Insurance Carrier:

If I do not name a doctor or if he/she cannot be contacted, I authorize the Oahu Club to contact any available doctor for treatment at my expense. In making this application, I agree to observe all rules and regulations established by the oahu club. In using The Club’s facility, I agree that I, my family members, and my guest assume the risk of damages or injury suffered in connection with or while engaged in any projects, functions or activities of The Club, and in this regard, I agree to indemnify and hold harmless Life Port Hawaii Co. LTD USA, INC. DBA The Oahu Club and the trustees of the Bernice Bishop Estate and each of their Parent, Subsidiary and affiliated companies, agents and employees, their predecessors, successors, and assign from any and all claims, demands, suits actions, cost or causes of any kind or character arising from such use.

Signature: __________________________________ Date: ____________