EXHIBIT _____

CONTRACTOR ACKNOWLEDGMENT AND RELEASE

This Acknowledgment and Release is attached to and made a part of the contract dated_______________ by and between the National Institutes of Natural Sciences and___________________________________ (“Contractor”) regarding certain work (the “Work”)
to be performed by Contractor at Subaru Telescope on the summit of Mauna Kea (the “Site”).
This Acknowledgment and Release is being relied upon and inures to the benefit of Institute for
Astronomy (IFA), National Astronomical Observatory of Japan (NAOJ), Subaru Telescope, theResearch Corporation of the University of Hawaii (RCUH), the Office of Mauna Kea
Management (OMKM), the University of Hawaii, and the State of Hawaii (the “TelescopeParties”).
1.
Contractor hereby acknowledges the risks set forth below related to the Work.
Contractor expressly agrees and accepts and assumes all such known and unknown risks
associated with working at the Site. Contractor also agrees to abide by all the rules andregulations as stated in the attached information sheets concerning general safety andunderstands and accepts the consequences that can result from not adhering thereto. Contractor
shall make each of its officers, principals, employees, agents, consultants, and any other person
entering the Site through or under Contractor (collectively “Contractor Personnel”) aware of therisks as set forth herein and shall obtain the agreement of each person within Contractor
Personnel to abide by all the rules and regulations as stated in the attached information sheets
concerning general safety and to understand and accept the consequences that can result from notadhering thereto. Contractor hereby releases the Telescope Parties from and waives any and allliability, claims, demands, actions and causes of action whatsoever arising out of or related to
any loss, damage, or injury, including death, that in any way arise from, are based upon,connected with or otherwise related to the risks set forth herein or a claim that Contractor was
unaware of the risks as set forth herein. Contractor shall defend and indemnify the Telescope
Parties from claims by Contractor Personnel from claims arising out of a failure by Contractor tocarry out the promises set forth herein.
2.

Contractor acknowledges, understands, and accepts:a.
All of the facts and information described in the attached information
sheets including HIGH ALTITUDE HEALTH HAZARDS and the SIGNIFICANT HEALTHRISKS inherent in working at, visiting, and driving to the Site.
b.
Working at the Site presents an inherent risk of injury, serious bodily harmor death. In particular, the risks include, but are not limited to, equipment failure of a motorvehicle, dangers of driving on paved and unpaved roads to the Site, vehicular traffic, actions ofother people, unavailability of professional emergency medical assistance, and the EFFECTS OF
HIGH ALTITUDE. Contractor understands the importance that none of the Contractor Personnel
perform the Work at the Site with any of the following RISK FACTORS:

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PregnantFeel unwell
Scuba diving within 24 hrs (48 hrs for repetitive or deep dives)
Feel anxiety about visiting the summit
Under 16 years of age
Have previously experienced health problems at high altitudeSuffer from cardio-pulmonary disease
Are anemic
Have a head cold or allergic rhinitis
Feel “hung over” or excessive alcohol consumption within 24 hrs
3.
Contractor shall obtain a statement from each person within Contractor Personnel
to the effect that:
I am qualified, in good health and in proper physical condition to participate in
the Work. I have no physical or mental condition which prevents me fromentering the Site in a manner that is safe for others and me. It is my responsibility
to take all appropriate actions in advance of, and while entering the Site. I further
acknowledge and agree that I have the responsibility to consult with my physician
to determine if medical conditions exist that would pose a direct threat to myhealth or the safety and health of others.
In the event that I sustain injuries or illness while at the site, I authorize Subaru
Telescope to administer, or cause to be administered, such first aid or othertreatment as may be necessary under the circumstances, to include treatment by aphysician or hospital of Subaru Telescope's choice. I accept full responsibility forany medical expenses incurred as a result of these actions.
If Contractor Personnel is under the age of 18, this statement is signed by hisparent or legal guardian on behalf of the parent/guardian and the minor.
4.
Contractor hereby further agrees that if any portion of this Acknowledgment isheld invalid, the balance of the Acknowledgment shall remain in full force and effect.

Contractor:________________________________________
By:__________________________________

Its:__________________________________

Dated: __________________________________

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HIGH ALTITUDE HEALTH HAZARDS
Subaru Telescope is located near the summit of Mauna Kea at 13,460 ft / 4,200 meter elevation, where the atmosphere has
only 60% of the oxygen found at sea level, about 10% of the moisture, and where the average atmospheric temperature isabout 32°F / 0°C.
The human body reacts to high altitude in a variety of ways. Individuals who are pregnant, have a head cold or sufferfrom cardio-pulmonary disease should not attempt to work at or visit the summit. SCUBA divers should not go toMauna Kea (Hale Pohaku (HP) altitude) within less than 24 hours of diving. This can lead to the bends (decompression
sickness / nitrogen narcosis). If you have made repetitive or deep dives or are in any doubt, you should extend this interval toat least 48 hours.
One of the body's reactions to high altitude is water dumping to allow the blood to carry more oxygen.
Frequent
urination is a symptom of this process. Failure to replace lost body fluids can lead to dehydration, severe headaches, andhypothermia.
High altitude dilation of the brain's blood vessels, combined with dehydration, can lead to aheadache as severe as a migraine. Telescope workers sometimes take aspirin or acetaminophen before departing HalePohaku (HP) for the summit to help avoid headaches.
Individual responses to altitude can vary greatly. No one is immune from the effects or the potential dangers. To lessen
the risk of high-altitude health hazards, be in good health, dress warmly, drink lots of fluids, avoid alcohol and drugs, and paceyourself.
It's important to acclimatize at least a 1/2 hour (1 to 1 ½ hours for first timers) at the Hale Pohaku (HP) facility or
the Visitor Information Station (VIS) (9,200 ft / 2,800 meter level) before going to the summit. Those who will stay at
the summit facility for more than eight hours are recommended to acclimatize at least 8 hours at the HP facility before
going to the summit. Anyone may not stay at the summit for more than 14 hours within any consecutive 24 hours.
Do not go alone to the summit. You may not always recognize the symptoms of altitude sickness in yourself. If you
feel the onset of any unusual feeling or symptom, let someone know immediately. If you notice someone who appears to besuffering from some unusual feeling or symptom, ask how he or she feels.

Major Emergency
Steps to Take

Major Symptoms

Major Signs

Severe Unrelenting Sudden
Headaches
Shortness of Breath (at rest)
Chest Pain
Abdominal Pain

Slurred Speech
Visual Disturbance
Loss of Coordination
Paralysis
Seizures
Collapse
Slow or Rapid Heart Beat
Labored Breathing
Cough with blood tinged sputum
Unrelenting Nausea or Vomiting

1. Evacuation: Follow the Mauna Kea Emergency
Procedures
2. Examine the victim
3. Call 911 with the following information:• Your Location• Describe how the accident or illness occurred• Describe the victim’s symptoms• Indicate the urgency needed for treatment• Describe the weather conditions• Establish the primary meeting place (SaddleRoad Junction)• Describe the vehicle used to transport the victim
4. Inform HQ Management

Minor Emergency
Steps to Take

Minor Symptoms






Mild shortness of breath
Dizziness
Light headedness
Headaches
Visual Change
Palpitations
Chest Tightness
NauseaRest
2.
Administer Emergency Medical Oxygen (fixed flowtype)3.
Descend to Lower Altitude (Hale Pohaku)
4.
Inform HQ Management
5.
If symptoms persist, proceed to a Medical Center
Emergency RoomFor detailed information, see: http://www.naoj.org/Information/Tour/Summit/index.html
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