Attachment 2 (waiver and meal form)

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To participate in Koa Ohan Day on July 14, please complete this form. $5 for BBQ, $15 for shirt

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Attachment 2 (waiver and meal form)

  1. 1. 8 4 th E n G IN E E R B A T T A L IO N KOA P R E S E N TS July 17, 2012 ~ 7:30 to 2:30 pm OHANA DAY KOA OHANA DAY REGISTRATION FORM All forms and monies need to be turned in to Company XOs NLT 271300JUN 12Participants Full Name: Participants Home Phone:Age: Participants Cell Phone:Home Address: Sponsor’s Full Name and Rank: Unit: Relationship:Emergency Contact’s Full Name: Emergency Contact’s Contact Number: ( ) Cell ( ) Home BBQ Lunch Information: The BBQ lunch will cost $TBD each. IF you would like to participate/purchase a lunch ticket please indicate the amount below. Amount of lunch tickets/meals you would like to purchase: Total $ Collected:_____________ Please Read Before Signing Medical Release: By signing below you agree to the following terms: I, the legal registrant, recognize the possibility of physical injury associated with any type of physical exertion or exercise. I herby release, discharge and/or otherwise indemnify the 84th Engineer Battalion, all its affiliated sponsors, their employees and volunteers, against any claim by the registrant because of the participation in the Koa Ohana Day Program.Participant’s Signature: Date Childcare Information: For more information about this event Child Youth Service will provide a limited number of please contact the acting FRSA: childcare slots on a first come, first serve basis. Spouse Jymette Watrousinterested in en-rolling their childen will be responsible to (808) 655-6651 pay for childcare cost and meals. Please contact Petersen Jymette.m.watrous@us.army.mil CDC for more childcare information: Petersen CDC (808) 655-5293 NE V E R DA UNT E D

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