VOLUNTARY RELEASE, WAIVER & ASSUMPTION OF RISK AND

CERTIFICATE OF COMPLIANCE

The Governor of the State of Hawai’i proclaimed a state of emergency in response to the COVID-19 pandemic,

and the State and County of Maui have issued Proclamations, rules and regulations to help minimize risks

associated with COVID-19.

To help keep the premises of the Association of Apartment Owners of Aina-Nalu (“Association”) safe, all

persons occupying a Unit at the Association shall complete this form. The use of the Association’s common

elements, facilities and amenities during the COVID-19 pandemic may involve inherent risks which may result

in serious health risks and/or death, not all of which can be foreseen.

I, the undersigned Participant, attest, understand and agree to the following (initial in each blank):

_____ I certify that I have not experienced or displayed any of the following COIVD-19 symptoms in the past

72 hours: Fever or chills, sore throat, cough, shortness of breath, or other respiratory symptoms, muscle aches,

severe fatigue, loss of taste or loss of smell.

_____ I certify that I have not had close contact with anyone over the last 14 days who is confirmed to have

COVID-19.

_____ I certify that ONE of the following is true (PLEASE CHECK ONE):

_____ I have received a negative test result for COVID-19 for a test taken no later than 72 hours prior

to flight departure to Maui consistent with the State of Hawai’i requirements; OR

_____ I am waiting to receive a test result for COVID-19 for a test taken no later than 72 hours prior to

my flight departure to Maui consistent with the State of Hawai’i requirements, and will quarantine until I receive

a negative test result or for 14 days, whichever is less; OR

_____ I will quarantine for 14 days upon arrival in Maui or for the duration of the stay, whichever is

longer.

_____ I understand that risks of COVID-19 include but are not limited to fever, headaches, sore throat, nausea,

stroke, disability, weight-loss, respiratory illness, inability to breathe, muscle aches, loss of sense of smell and

taste, and death, and it can easily be contracted from person to person.

_____ I agree to abide by all State and County Proclamations and rules, including not limited to, social

distancing of at least six feet, using masks when not exercising, and avoid gatherings of persons not from my

residence.

_____ I agree to follow all signs, rules and regulations, which signs, rules and regulations may be changed from

time to time by the Association.

_____ I understand that risks associated with the use of the Amenities are beyond the control of the Association,

and cannot be eliminated with due care. I have chosen to use the Amenities voluntarily and having full

knowledge of the risks associated with my participation.

(CONTINUED ON NEXT PAGE)

_____ I AGREE ON MY OWN BEHALF AND ON BEHALF OF MY CHILDREN AND ALL OTHERS IN

MY CARE, CUSTODY, OR CONTROL (HEREAFTER INCLUDED IN “I” OR “MY”) TO ASSUME FULL

RESPONSIBILITY FOR ABIDING BY THE PROVISIONS HEREIN, THE PROCLAMATIONS AND

RULES, AND FOR THE RISKS ASSOCIATED WITH COVID-19 WHEN USING THE AMENITIES. I

HEREBY RELEASE FROM LIABILITY AND WAIVE ANY AND ALL CLAIMS THAT I HAVE OR MAY

HAVE IN THE FUTURE AGAINST THE ASSOCIATION, AND ALL RESPECTIVE OFFICERS,

DIRECTORS, EMPLOYEES, AGENTS, PRINCIPALS AND REPRESENTATIVES (HEREAFTER

COLLECTIVELY REFERRED TO AS “RELEASEES”), AND I VOLUNTARILY AGREE TO FULLY AND

FOREVER RELEASE AND DISCHARGE RELEASEES FROM LIABILITY FOR DAMAGES FOR

INJURIES RESULTING FROM, ARISING OUT OF, OR RELATED IN ANY WAY TO THE RISKS

IDENTIFIED HEREIN AND THOSE RISKS NOT SPECIFICALLY IDENTIFIED AND FOR ANY OF MY

USE OF THE AMENITIES. I VOLUNTARILY WAIVE MY RIGHT TO SUE RELEASEES FOR ANY

INJURIES OR DAMAGES, INCLUDING PROPERTY DAMAGE, THAT MAY RESULT FROM, ARISE

OUT OF, OR BE RELATED IN ANY WAY TO THE COVID-19 RISKS IN USING THE AMENITIES.

____ I ACKNOWLEDGE THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE

DOCUMENT AND THAT I HAVE READ THIS ENTIRE DOCUMENT, UNDERSTAND ITS TERMS AND

AGREE TO BE BOUND BY THEM. I AGREE THAT THE RESPONSES AND CERTIFICATIONS MADE

ABOVE ARE ACCURATE. I UNDERSTAND THAT THE EFFECT OF THIS DOCUMENT IS THAT I AM

RELEASING LIABILITY AND WAIVING MY RIGHT TO SUE OR BRING ANY CLAIM OF ANY KIND

OR NATURE AGAINST THE RELEASED PARTIES AND I AM ASSUMING ALL RISKS OF INJURY OR

DAMAGE RESULTING FROM, ARISING OUT OF, OR RELATING IN ANY WAY TO MY USE OF THE

AMENITIES. I UNDERSTAND THAT THIS DOCUMENT APPLIES TO AND SHALL BE EFFECTIVE

AND BINDING UPON ME, MY HEIRS, ASSIGNS, PERSONAL REPRESENTATIVE, ESTATE, ALL

MEMBERS OF MY FAMILY INCLUDING MY CHILDREN, AND ALL OTHERS IN MY CARE,

CUSTODY, OR CONTROL.

If any portion of this Document shall be declared unenforceable for any reason, the unenforceable portion shall be

considered severed from the Document and the remainder of the Document shall not be affected and shall be valid

and enforceable to the fullest extent permitted by law. Any and all disputes concerning this Document shall be

subject to Hawai’i law and shall take place on the Island of Maui.

Unit No. __________________ Dated: ____________________________________

Participant’s Name (print): _______________________________

Participant’s Signature: ________________________________

Participant’s Phone No.: _____________________________________

PARENTAL CONSENT FOR MINORS

I certify that all persons in my care who are under the age of 18 or who are dependent on my care, meet the

criteria described above.

Minor(s) Name(s) ________________________________________________________________

Minor(s) Age(s) _________________________________________________________________

Parent/Guardian Name (print):__________________________________________________________

Parent/Guardian Name Signature:___________________________________________________________