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Give
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Membership Registration 2024
Hinano Wizard
2024-06-04T16:09:28-10:00
Mahalo for coming here to become a member of Waimanalo Canoe Club. To complete this membership form you will need to be able to upload a picture of yourself and upload a drivers license or birth certificate (keiki). Straight from your smart phone works great. Come back later when you have those documents in hand.
Hidden
Membership End Date
Month
Day
Year
Paddler Name:
(Required)
First
Last
Gender
(Required)
Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Birthdate
(Required)
MM slash DD slash YYYY
Phones
(Required)
Mobile/SMS
Phones
Phones: Home
Email
(Required)
IN AN EMERGENCY CONTACT:
Parent or Legal Guardian
First
Last
Upload Identification Document (Drivers license, passport, military ID, birth certificate, etc.)
(Required)
Upload digital picture of face (for paddling ID). No hats or sunglasses, like a passport photo.
(Required)
Waimanalo Canoe Club Member Profile
Hawaiian Name or Nickname
Paddle Shirt Size
XS
S
M
L
XL
XXL
XXXL
New/Returning
A New Member (1st time with Waimanalo Canoe Club)
A Returning Member (renewing)
Last Classification (Pick One)
Keiki (Age 8-11)
Juniors (Age 12-18)
Novice B
Novice A
Open
Can You Swim?
(Required)
Yes
No
New or Experienced Paddler?
Are you transferring from another club? If yes, provide the name of the club and classification. You may also describe your paddling or coaching experience if you wish.
Age on January 1st, 2023
(Required)
Years of Age. Whole numbers only. Example: 28
Please enter a number from
7
to
99
.
I am the parent or legal guardian of the registrant, who is a minor, and I agree to allow them to participate as a member in WCC's 2024 paddling season.
(Required)
I Consent
Parent Name - Emergency Contact
Emergency Contact Phone
(Required)
(For applicants under 18, please list a parent/guardian as the emergency contact. You may add additional information or contacts in the "additional information" box below.
Medical Coverage
Any medical problems we should be aware of?
(Required)
Family Physician (PCP)
PCP Phone Number
Insurance Carrier
Subscriber ID
Subscriber
Policy #
Group #
Agreements
Fundraiser Agreement
(Required)
I understand that:
Every member is responsible to sell ALL tickets or items issued for any fundraising event, and to be responsible to pay for any unsold or lost amounts. No tickets or items may be returned once issued. Every member will participate in the Waimånalo Regatta and fundraising events.
I agree
Refund policy
(Required)
I understand that my club membership/registration fees are payable on or before June 1 2024, and there will be NO refunds of fees.
I agree
Photo Release
(Required)
Waimanalo Canoe Club hereby has permission to photograph, film or otherwise record and use images of myself and/or my child/childrens' name, voice, and/or likeness, bibliographical identification, and/or work for educational purposes and for publicizing and promoting WCC and its activities.
I agree
Optional: Ethnicity
Native Hawaiian / Part Hawaiian
Reside on Hawaiian Homelands (Homestead)
Ethnicity is listed on birth certificate
Registered with OHA (Office of Hawaiian Affairs)
Specify if Native American
How many adults in household?
How many children in household?
Specify if other Pacific Islander
Secondary Language (if any)
Check all that apply:
Filipino
Chinese
Japanese
Korean
Portugese
African American
Hispanic
Caucasian
Other Ethnicity
Is there any additional Information you wish us to have?
Adult Sign CLUB Membership Agreement
This release is executed, between Waimanalo Canoe Club (“CLUB”), of Waimanalo, Hawaii. I, Releaser, being over the age of 18 years, in consideration of being permitted to participate in the sport of canoe paddling with the CLUB, do hereby release and hold harmless the CLUB from any and every claim, demand, action or right of action, of whatever kind or nature arising from or by reason of any injury to me known or unknown death, or property damage resulting from any accident which may occur because of participating in canoe paddling or any activities in connection with canoe paddling (including social activities), whether by negligence or not. I further release all members and coaches from any claim whatsoever I may have on account of first aid, treatment or service rendered me during my participation in this sport. This release contains the entire agreement between the CLUB and me and the terms of this release are a contract. I have read this release, I understand it, and I sign it as my own free act. I understand that before I sign, I may have my attorney review this release and he or she can explain in detail the full extent of the legal rights I am giving up. IN WITNESS WHEREOF, Releaser has executed this release.
Signature
(Required)
Guardian Sign CLUB Membership Agreement
As adult Parent Guardian of Minor Applicant do hereby authorize my child to participate in 2022 Canoe Racing Season as a member of Waimanalo Canoe Club. I do hereby release and hold harmless the CLUB from any and every claim, demand, action or right of action, of whatever kind or nature arising from or by reason of any injury to my child known or unknown death, or property damage resulting from any accident which may occur because of participating in canoe paddling or any activities in connection with canoe paddling (including social activities), whether by negligence or not. I further release all members and coaches from any claim whatsoever I may have on account of first aid, treatment or service rendered to my child during his/her participation in this sport. This release contains the entire agreement between the CLUB and me and the terms of this release are a contract. I have read this release, I understand it, and I sign it as my own free act. I understand that before I sign, I may have my attorney review this release and he or she can explain in detail the full extent of the legal rights I am giving up. IN WITNESS WHEREOF, Releaser has executed this release.
Signature
(Required)
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