1. 8 4 th E n G IN E E R B A T T A L IO NKOA P R E S E N TSJuly 17, 2012 ~ 7:30 to 2:30 pmOHANA DAYKOA OHANA DAY REGISTRATION FORMAll forms and monies need to be turned in toCompany XOs NLT 271300JUN 12Participants Full Name: Participants Home Phone:Age:Participants Cell Phone:Home Address: Sponsors Full Name and Rank:Unit:Relationship:Emergency Contacts Full Name:Emergency Contacts 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 andvolunteers, against any claim by the registrant because of the participation in the Koa Ohana Day Program.Participants Signature:Date Childcare Information:For more information about this event Child Youth Service will provide a limited number ofplease contact the acting FRSA:childcare slots on a first come, first serve basis. SpouseJymette 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