WAIVER FORM

BWS Rain Barrel Waiver

CITY AND COUNTY OF HONOLULU
WAIVER OF CLAIMS AND DEFENSE AND INDEMNITY AGREEMENT

All participants must meet the following requirements in order to purchase a rain barrel from the Board of Water Supply:

Present valid photo ID upon check-in
Complete the waiver form below
Maintain minimum distance of 6 feet from others as space allows
A mask covering both nose and mouth is recommended while on site

Rain Barrel Waiver

Please read and accept the following statements *

Check the box after reviewing the acknowledgement (required).

The undersigned was advised and understands that the rain barrel (“Barrel”) provided by the Honolulu Board of Water Supply (“BWS”) to the undersigned as a part of the BWS rain barrel program for NON-POTABLE USE, at one time may have been used to store certain chemical substances, including but not limited to residual rinsate, which originally contained sodium hypochlorite solution or food grade substances, including but not limited to food grade flavoring. The undersigned has been advised by the BWS that the BWS has taken steps to rinse the Barrel before the undersigned was given the Barrel. The BWS also advised the undersigned to fill the Barrel and dispose of the filled water at least once before using water from the Barrel on the undersigned’s property. The Barrel has a designated pick up date(s) and if the Barrel is not picked up on the date(s) specified, there may be a delay in receiving the Barrel based on availability. Any rescheduling of the Barrel pick up shall be at the sole discretion of the BWS. There will be no refunds for rain barrels and the BWS is not responsible for associated damages of the undersigned’s property due to leaking barrels.

Claims 2 *

Check the box after reviewing the acknowledgement (required).

The undersigned assumes all risks associated in the use of the Barrel, and also waives all claims against the BWS and Coca-Cola Company (“Coca-Cola”) and Phoenix V LLC, dba BEI Hawaii (“BEI”) (which the undersigned understands provided the BWS with the Barrel) for personal injury, property damage, death, or loss accruing or arising in any manner whatsoever from undersigned’s use of the Barrel. The undersigned also agrees to defend and indemnify the BWS and Coca-Cola against any claims arising out of the undersigned’s use of the Barrel.

Claims 3 *

Check the box after reviewing the acknowledgement (required).

I acknowledge that this questionnaire was completed truthfully and to the best of my knowledge.

First Name *

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Last Name *

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Street Address *

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City *

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State *

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Zip Code *

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Phone *

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Email *

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Name *

To complete this waiver, enter your FULL LEGAL NAME.

Date *

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Waiver Disclaimer *

Check the box after reviewing the acknowledgement (required).

I understand and acknowledge that BWS will maintain the confidentiality of this record in accordance with applicable laws and to the extent practicable under the circumstances. However, the information collected on this form may be disclosed to the appropriate governmental agency pursuant to any reporting obligations and requirements under state or federal law.

Updated: 03/28/2026

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WAIVER FORM

BWS Rain Barrel Waiver

CITY AND COUNTY OF HONOLULU
WAIVER OF CLAIMS AND DEFENSE AND INDEMNITY AGREEMENT

WAIVER FORM

BWS Rain Barrel Waiver

CITY AND COUNTY OF HONOLULUWAIVER OF CLAIMS AND DEFENSE AND INDEMNITY AGREEMENT

CITY AND COUNTY OF HONOLULU
WAIVER OF CLAIMS AND DEFENSE AND INDEMNITY AGREEMENT