Application for SERVICE PROVIDER PERMIT Effective: 09/08/25

Application for Service Provider Permit To: Administration Office, Kalaupapa Settlement DATE: _______________ Note: Permits must be submitted at least three (3) BUSINESS DAYS prior to visitor arrival.

The DOH administration cannot guarantee flight availability for settlement access on chosen dates.

I, __________________________________, on behalf of our organization ________________, request permission to have the following Service Provider(s) at Kalaupapa Settlement.

TRAVEL BY: □PLANE □TRAIL □OCEAN [submit with approved NPS permit]

FROM: _______________ TO: ________________ STAYING AT: __________________

Date of Arrival Date of Departure

Tag Full Name of Visitor (please print) Home address & Emergency Phone contact #

Address:

Phone:

Address:

Phone:

Address:

Phone:

Address:

Phone:

Address:

Phone:

Address:

Phone:

By signing below as a representative of my agency, I certify that our service provider(s) will be fully informed of, and will comply with, the Kalaupapa Settlement Rules & Regulations during their visit. I further confirm that I have provided each individual, prior to arrival, with a copy of Attachment B, which outlines these Rules & Regulations for visitors. I understand that, as a sponsor, I am responsible for ensuring compliance with these rules and that the Kalaupapa Administration reserves the right to investigate potential violations by visitors and/or their sponsors. I acknowledge that penalties may include temporary suspension of sponsorship privileges, permanent banning of offenders, or other sanctions as deemed appropriate by the Kalaupapa Administrator.

Sponsor/Sponsoring Agency Representative

Sponsor’s e-mail address

Above request is granted on ___________________, SUBJECT TO RULES & REGULATIONS GOVERNING KALAUPAPA SETTLEMENT AND REVOCABLE.

Kalaupapa Administrator, Kalaupapa Settlement

EFFECTIVE: 09/08/25

ATTACHMENT B

ATTACHMENT B

VISITOR RULES & REGULATIONS FOR KALAUPAPA SETTLEMENT

SPONSORS: All patients, all employees, certain DOH volunteers and some representatives of ecclesiastical organizations that have a current agreement with NPS may sponsor visitors.

VISITORS: All visitors must present a state or government-issued photo identification upon sign-in at the State Administration Office, i.e., Driver’s License, State ID, etc.

ALL IDs MUST HAVE BIRTH DATE ON THEM.

The current daily visitor limit is ONE HUNDRED (100) sponsored guests within Kalawao County at any given time.

All visitors to the Settlement are required to display their respective assigned visitor tag on their person at all times.

REGISTRATION: Registration at the DOH Administration Office is required of ALL visitors immediately upon arrival. Each visitor receives their assigned visitor tag upon registration. For visitor arrivals outside of office hours, sponsors are required to pick up the sign-in sheet and the assigned visitor tag(s) in advance. The visitor permit sign-in sheet with all visitor signatures must be submitted to the admin office on the next immediate business day.

Please, note that an emergency phone number of an individual outside of the settlement is required on the sign-in sheet. Applicable accommodation fees are due upon arrival.

Anyone visiting the Settlement without a sponsor and signed permit is TRESPASSING and subject to legal action.

MAXIMUM STAY: NO VISITOR will be permitted to spend more than thirteen (13) days per calendar quarter in Kalaupapa Settlement.

The maximum “continuous” stay during any visit at Visitors’ Quarters, Wilcox and VET’s Cottage is limited to seven (7) days and six (6) nights per individual.

HOSTS/SPONSORS: Sponsors MUST be present in the settlement for the entire duration of their sponsored visitor’s stay.

Should a sponsor need to be away from the settlement at any time during their visitors stay, an additional sponsor may/can be allowed to sign the permit and assume all sponsorship responsibilities during any absences of the original sponsor.

Visitors must be accompanied by their sponsor(s) at all times outside of the settlement – specifically:

• Beyond the cattle guards located on Damien Road leading east toward Judd Park;

• Beyond the cattle guard on the dirt road leading toward the light house and beaches (dirt road adjacent to Kamehameha Street near the airport)

VISITATION OF MINORS: Children under the age of sixteen (16) are not permitted in Kalaupapa Settlement.

PHOTOGRAPHY/VIDEO: By law, photographs and video of patients and/or their property may NOT be taken without their written permission. Photograph and video permits are available at the State of Hawaii Administration Office and must be completed and submitted ahead of time. Photo/Video permits require patients’ signature, prior to being reviewed/approved by the DOH administrator.

Recording, Filming or Still Photography of any kind (still, video and audio) may require a NPS Special Use Permit. For more information visit:

https://www.nps.gov/kala/planyourvisit/index.htm

HOSPITAL: THERE ARE NO MEDICAL OR EMERGENCY SERVICES AVAILABLE IN

KALAUPAPA.

If you are sick, or have flu-like symptoms, such as fever, body ache, runny nose, nausea, coughing, etc., do not visit the Settlement.

If you require medical attention or medical services while in Kalaupapa, inform your sponsor. An emergency medical response via helicopter from a neighboring island may take hours.

In case of emergency, call 911 immediately. Be aware that the scarcity of cell phone reception on the peninsula may make calling for help difficult.

CARE HOME The Kalaupapa Care Home exists solely for the care of our remaining patients that live in Kalaupapa. Visitors requesting to meet with individual patients in the Care Home should have their sponsor call the Care Home prior to their arrival to inquire about a potential appointment. An approved Visitor Permit does NOT include permission to enter the Kalaupapa Care Home. All requests for Care Home visits are subject to the review and decision of the Care Home’s Nursing Supervisor.

RESTROOMS: Public restrooms are located at the Airport Terminal, the DOH Administration Building, Slaughterhouse, and Judd Park.

https://www.nps.gov/kala/planyourvisit/index.htm

VISITORS’ QUARTERS: Check-In 2:00PM, Check-Out 12:00 Noon

Please inform Administration staff if you need an early check-in and/or late check-out time. If you fail to notify Admin office staff of a late check-out time, our housekeepers have the right to gather all your personal belongings and set them aside in order to proceed with their duties.

Visitors are solely responsible for the safety of their belongings.

Please DO NOT REMOVE any State-owned items from Visitors’ Quarters, Wilcox or VET’s cottage.

Observe cleanliness and recycling instructions in common spaces, such as shared kitchens and bathrooms. If the visitor(s) leave(s) excessive and/or improperly sorted trash behind, their sponsor will be held liable and sponsorship rights withdrawn temporarily at the discretion of the Kalaupapa Administration.

Female hygiene products: Please, dispose of these in the available trash cans. Our plumbing CANNOT handle flushed tampons and sanitary pads/napkins.

FOOD: There are no restaurants in Kalaupapa, so please, plan for your needs and bring your own food, beverages and sundry items.

Visitors may purchase a single soda, and a candy or a bag of chips per day at the Kalaupapa Store, but shopping for groceries is PROHIBITED.

LIBRARY: The library is NOT open to the public. Please have your sponsor check with National Park Service if you wish to use library resources. Removal of materials from the library is strictly prohibited.

DRIVING IN THE

SETTLEMENT:

If you intend to drive during your visit, please exercise the utmost caution and move onto the road shoulder if you see incoming vehicles – many of our residents have visual and hearing impairments, deer are pervasive within settlement bounds, and the occasional wild boar are unpredictable.

Please, always be vigilant and aware of your surroundings.

SPEED LIMITS: All drivers are expected to comply with the following speed limits:

• Hospital Zones 15 MPH

• Unit Home Drives 15 MPH

• Within the settlement proper, incl. the inner cattle guards 25 MPH

• Outside the settlement proper 35 MPH

AUTOMOBILE

PASSENGERS:

All vehicles and operators must comply with all state and federal traffic regulations. Failure to comply with federal and state regulations can result in penalties, fines, and/or arrest.

REMINDER:

State law (HRS §291-14) only permits passengers to ride in the back of pickup trucks when:

• There is no seating available in the cab

• The tailgate is securely closed, and side racks are securely attached

• Every passenger in the bed is seated and does not attempt to control unlashed cargo.

HUNTING: Visitors are NOT PERMITTED to hunt or accompany a resident hunter on a hunt. Visitors are NOT PERMITTED to carry firearms.

CAMPING: Camping is NOT ALLOWED anywhere.

USE OF NATURAL

RESOURCES:

All applicable state and federal fish and game rules and regulations must be respected. Any violations of the Settlement’s fish and game rules will result in the visitor being declared unwelcome and banned from future visits to Kalaupapa.

Visitors may only fish with poles. No NET fishing is allowed. No opihi picking. No fishing equipment or the cleaning of fish is allowed in any building, except for Lion’s Club “Ocean View” Pavilion when accompanied by a sponsor.

Harvesting of sea salt is to be done under the sponsor’s supervision.

Please, take only what you need. Be mindful of others. Taking excessive amounts of sea salt will result in the visitor being declared unwelcome and, based on the severity of the violation, temporarily or permanently banned from future visits to Kalaupapa. Note: No Trespassing on DOT property, including runway area.

Violations of the Kalaupapa fishing and sea salt harvesting policy should be reported to the Kalaupapa Settlement Administrator immediately following the alleged violation. For safety concerns, no diving tanks or scuba are allowed. No surf boarding or boogie boarding. No diving off the pier.

NO ANIMALS: Visitors are not permitted to bring animals of any species into the Settlement.

If a visitor requires the assistance of a service animal, their sponsor must formally request permission from the Administrator in advance.

NATIONAL HISTORIC

LANDMARK PROTECTION

The entire peninsula is designated as a National Historic Landmark (NHL).

Respect archeological and cultural sites. Do not remove artifacts or alter the landscape.

INHERENT RISKS Kalaupapa Settlement, located within Kalawao County on the Makanalua Peninsula, is a remote and historically significant area overseen jointly by the Hawai‘i State Department of Health (DOH) and the U.S. Department of the Interior, National Park Service (NPS). The Settlement is managed by DOH primarily to provide care and residence for individuals previously institutionalized due to Hansen’s Disease and is not designed or operated as a conventional tourist destination.

• Visitors understand that Kalaupapa is a remote and undeveloped environment, with limited infrastructure and emergency services.

• Activities undertaken during the visit may expose individuals to serious hazards, including but not limited to:

o Wildlife encounters o Natural disasters (e.g., tsunamis, landslides, hurricanes) o Sudden weather changes o Rugged terrain and limited accessibility

Visitors voluntarily assume all risks of injury, illness, property damage, or death, regardless of cause or circumstance.

Since the entire peninsula is designated as a National Historic Landmark (NHL) additional oversight and permitting of the construction, management and maintenance of facilities (e.g., road paving, building modifications, street lighting) is required. All improvements are guided by DOH’s goal to care for patients and NPS’s efforts to balance the goals of protecting, preserving and interpreting the cultural, historic and natural resources of Kalaupapa.

The entirety of Kalawao County/Kalaupapa National Historical Park is therefore NOT designed for, or operating as a typical tourist destination. It is the responsibility of all Sponsors and Visitors to be aware of the inherent risks which may contribute to injury or harm during their stay. By agreeing to visit, all visitors understand and willingly assume these risks, regardless of the cause and circumstances.

WILDLIFE

When you visit national parks, you are entering animals’ habitat and should behave like a polite guest. In fact, your safety and health, and that of wildlife depends on the thoughtful choices park visitors make.

Risks from wildlife in national parks include potential attacks or injuries to visitors from animals that are startled, aggressive, or food-conditioned, as well as diseases transmitted between humans/pets and wildlife.

Additionally, human activities like feeding wildlife, improper trash disposal, and getting too close can lead to food conditioning and increased aggression, ultimately resulting in harmful interactions for both people and animals.

WALKING IN THE

SETTLEMENT AT NIGHT,

OR WHEN

LIGHTING/VISIBILITY IS

POOR

Should pedestrians choose to move about the Settlement at night, or when lighting/visibility is poor they should:

1) use a lighting device that can:

• illuminate their immediate surroundings, so that they may spot potential trip or fall hazards such as curbs, potholes, uneven pavement, debris or steep downward slopes,

• allow drivers and other pedestrians to see them from a distance

• act as an additional deterrent to both wildlife and potential human threats.

2) wear light colored and/or reflective gear.

LITTERING: Please be respectful of this peninsula, known as Makanalua in ʻŌlelo Hawaiʻi. Be aware of and fulfill your responsibility to maintain its pristine beauty as a steward of the ‘aina (land) and all that lives and grows here.

ATTITUDE: Honor and respect the history of those who once lived here and contribute to the protection of this unique place which those who still reside here unequivocally call "Home."

NO TRESPASSING: Trespassing onto off-limit administrative buildings, personal residences and yards is strictly prohibited, including to pick fruit, vegetables or flowers.

BEFORE YOU LEAVE: Make sure you return all assigned visitor tags and have paid your accommodation fees if applicable. Do not leave unsorted or excessive trash behind.

ANY VIOLATION OF THESE RULES GOVERNING ALL VISITORS WILL RESULT IN DISCIPLINARY

ACTION AND SUSPENSION OF VISITATION AND SPONSORSHIP PRIVILEGES.

ATTACHMENT B – VISITOR ACKNOWLEDGMENT SIGNATURE

KALAUPAPA RISK ACKNOWLEDGMENT AND LIABILITY WAIVER

By entering Kalaupapa, all visitors acknowledge and accept the following:

1. Assumption of Risk

• Visitors understand that Kalaupapa is a remote and undeveloped environment, with limited infrastructure and emergency services.

• Activities undertaken during the visit may expose individuals to serious hazards, including but not limited to:

o Wildlife encounters o Natural disasters (e.g., tsunamis, landslides, hurricanes) o Sudden weather changes o Rugged terrain and limited accessibility

• Visitors voluntarily assume all risks of injury, illness, property damage, or death, regardless of cause or circumstance.

2. Limited Services and Emergency Response

• Medical, transportation, and communication services are extremely limited.

• Emergency response times may be delayed significantly due to geographic isolation.

• Visitors are responsible for their own safety and preparedness, including bringing necessary supplies and understanding the terrain.

3. Historic and Cultural Protections

• Kalaupapa is designated as a U.S. and State Historic Landmark.

• All facilities and infrastructure are managed with the intent to preserve cultural, historical, and natural resources.

• Construction, modification, or unauthorized activity is strictly prohibited without appropriate permits.

4. Purpose of the Settlement

• Per Hawai‘i Revised Statutes §326, Kalaupapa Settlement is maintained by the DOH for the care and treatment of persons with Hansen’s Disease.

• Visitor access is restricted and regulated by the Department of Health.

5. Release of Liability By entering Kalaupapa, visitors hereby release and hold harmless the State of Hawai‘i, the Department of Health, the National Park Service, and any affiliated agencies, employees, or representatives from any and all liability for personal injury, death, property loss, or other damages incurred during their visit.

ATTACHMENT B – VISITOR ACKNOWLEDGMENT SIGNATURE

By signing below or proceeding with entry, you confirm that you have read, understood, and voluntarily accept the terms of the “KALAUPAPA RISK ACKNOWLEDGMENT AND

LIABILITY WAIVER”.

SPONSOR NAME:

SPONSOR SIGNATURE:

SPONSOR E-MAIL:

DATE OF ARRIVAL DATE OF DEPARTURE:

By signing below or proceeding with entry, you confirm that you have read, understood, and voluntarily accept the terms of the “KALAUPAPA RISK ACKNOWLEDGMENT AND

LIABILITY WAIVER”.

Tag # Visitor(s) Full name Signature Date