The document is a registration form for an Ohana Day event being held by the 84th Engineer Battalion on July 17th from 7:30 am to 2:30 pm. It requests participants' contact information and includes a medical release and liability waiver. Childcare will also be provided by the Child Youth Service on a first come, first served basis, with parents responsible for costs. For more information, contact the acting FRSA Jymette Watrous.

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 12
Participants 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 Watrous
interested 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