Splash & Dash at Camp Mokule‘ia

Entry Fees	Jun 01, 2025 - Jul 20, 2025	Jul 21, 2025 - Sep 20, 2025	Sep 21, 2025 - Sep 28, 2025
Adult Category	$65.00	$75.00	$85.00
Youth Category	$45.00	$55.00	$65.00

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Category

Adult Category
Ages 18 and over $65.00
Youth Category
Ages 17 and younger $45.00

Team

Do you wish to create a new team, or join an existing team?

Create New Team
Join Existing Team

Participant Info

First Name

Last Name

Date of Birth

Gender

Male Female

Occupation

Will you be wearing a wetsuit?

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Custom price category checkbox2

Custom price category checkbox3

Custom price category checkbox4

Custom price category checkbox5

Custom price category checkbox6

Address

Address Line 1

Address Line 2

City

State/Province
Please use 2 letter abbreviation

ZIP or Postal Code

Country

Contact Info

Day Phone

Email Address

Email Address Confirmation

Emergency Contact

Emergency Contact Phone Number

Triathlon Relay Team

Team Info

Select or Create a Team

Team Name

Team Password

Team Password Confirmation

Select Number of Team Members

Division

Swimmer

Swimmer Name

Swimmer Date of Birth

Swimmer T-Shirt Size

Swimmer USAT Number

Biker

Biker Name

Biker Date of Birth

Biker T-shirt Size

Biker USAT Number

Runner

Runner Name

Runner Date of Birth

Runner T-Shirt Size

Runner USAT Number

Optional Donation - Please support Camp Mokulēʻia

Camp Mokulēʻia, upholding Christian and Hawaiian values, is dedicated to maintain, develop, sustain and care for its natural resources, offer a safe gathering place for all who enter, and provide for Christian ministry through intentional service to spiritual needs of the Episcopal diocese and the community.

Extra Donation Amount
$

Waiver

ALL PARTICIPANTS MUST READ AND SIGN THIS WAIVER:
I acknowledge that this event is an extreme test of a person’s physical and mental limits and carries with it the potential for death and property loss. I hereby assume the risks of participating in this event
and certify that I am physically fit, have sufficiently trained for participation in this event and have not been advised otherwise by a qualified medical person. I acknowledge that this form will be used by the event organizer and the sponsors and partners of this events. I hereby take action for myself, my executors, administrators, heirs,
next of kin and successors, and assign as follows: a) WAIVE, RELEASE, AND AGREE NOT TO SUE, from any and all liability for my death, disability, personal injury, property damage, property theft, or action
of any kind which may hereafter accrue to me as a result of any participation in or my traveling to and from this event, THE FOLLOWING PERSONS OR ENTITIES: event organizer, event sponsors, race directors,
representatives, agents and volunteers; b) INDEMNIFY AND HOLD HARMLESS the persons or entities mentioned in this paragraph from any and all liabilities or claims made by other individual or entities
as a result of any of my actions during this event.

I have read this agreement and fully understand its terms. I understand that I have given up substantial rights by signing it, and sign in it freely and voluntarily without any inducement.

Digital Signature of Participant (Type your full name here)

PARTICIPANTS UNDER THE AGE OF 18 ARE REQUIRED TO HAVE PARENT SIGN: This is to verify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and, for myself, my heirs, assigns, and next of kin, release and agree to indemnity and hold harmless the Releases from any and all liabilities incident to my minor child's involvement of participation in the events as provided above, even if arising from their negligence.

Digital Signature of Parent Or Guardian (only required if the participant is under the age of 18)

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