Registration Form – Kaleinani O Ke Kukui

Student Information

First Name

Last Name

Age

Birthdate

Dance/Music Experience

How did you hear about Kaleinani O Ke Kukui?

Contact Information

Contact Email

Phone Number

Parent/Guardian First NameN/A if over 18

Parent/Guardian Last NameN/A if over 18

Emergency Contact

Relationship

Phone Number

Pre-Registration Information

I agree to the AGREEMENT TERMS AND CONDITIONS

I agree to the POLICIES AND PROCEDURES

Student Signatureyour full name

Date

Parent/Guardian Signaturetype N/A if over 18

Date

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