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An application form for students of kapcc to register for intramural sports, including basketball and indoor dodgeball, during the spring 2020 semester. The form includes eligibility criteria, student certification statement, and risk and release form. Students must be enrolled in a minimum of six credits and have a cumulative gpa of 2.0 to be eligible. The registration period and locations for each sport are also provided.
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Date Submitted____________________ Paid: _________ ID?____________ Initial:_________________
(Print) Name: ______________________________ ______________________________ __________ LAST FIRST MI
STUDENT ID #: _____________________________ EMAIL:______________________@hawaii.edu
KapCC Credit Hrs for SPRING 2020 ____ T-Shirt Size (circle one): Med Large XLarge
Cumulative KapCC grade point average (GPA) as of FALL 19 ________________________
Mark an “X” in the box by the KapCC intramural sport(s) you would like to register for:
January 13 – January 17 January 27 – March 23
January 13 – March 27 April 8 – May 6
SPORTS: Basketball LOCATIONS: Pearl City District Gym TIMES: Mondays from 5:30pm–9:00pm
SPORTS: Indoor Dodgeball LOCATIONS: Halawa Gym TIMES: Wednesdays from 6:00pm–8:00pm
Along with this form you must also sign-up online
KAPCC INTRAMURAL SPORTS Student Eligibility Criteria
Note: If the number of applications exceeds the number of openings allocated to KapCC students for a particular sport or team, there will be a lottery held by the OSA to decide the KapCC participants.
STUDENT CERTIFICATION STATEMENT I attest that I have read, understand and accept the cited eligibility criteria for participation in the KapCC Intramural Sports Program for SPR 2020. Additionally, I freely consent to sign the required Risk and Release form. Moreover, I affrm that the accompanying Student Application for KapCC Intramural Sports Program participation information and KapCC Intramural Sports Risk & Release Form are true and accurate. Furthermore, to help defray the cost of any $120 penalty fee for each game forfeiture during the sports season, I agree to make an initial $10 deposit for each intramural team sport for which I have signed-up. If additional funds for game forfeitures become necessary, I agree to pay a prorated share of any and all such game forfeiture penalty charges assessed to the KapCC intramural sport team captain, who is ultimately responsible to pay any $120 game forfeiture penalty. Otherwise, s/he will incur a UH fnancial obligation until paid in full. All students eligible for a refund of their $10 intramural team sport deposit must submit their claim with their receipt at the Offce of Student Activities, during regular OSA hours, no later than two weeks after the completion of the particular intramural team sport in which they competed, or the $10 cash deposit becomes the property of the OSA.
I authorize Kapi‘olani Community College Office of Student Activities (OSA) to
photograph or videotape me and consent to the use of my likeness in any and all
publications, educational material, research, advertising, news media, video, and
World Wide Web materials; and I acknowledge the College’s right to crop and treat
the photograph and/or video at its discretion. I further understand and agree that
these materials may be kept on file and/or be used by Kapi‘olani Community
College for potential future uses and further agree to release the College from any
and all liability arising from or in connection with taking, use, publication, or
dissemination of such materials.
Choosing to not sign this release will result in your not being able to participate in the OSA activity/event for which this form has been designated.
*Please have all participating members fill out the Photo release form