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I had a great
first lesson.

Mahalo!
With aloha

Gale Luanapiliki‘i Warshawsky

APPLICATION

Please fill out the form completely. The fields with red asterisks must be filled in. Contact us if you have any questions or concerns.

Last Name: *

First Name *

Date of Birth: *

Gender: *

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E-mail Address: *

Street Address: *

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City: *

State/Prefecture: *

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Best Contact Number: *

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Father/Legal Guardian Name (Last, First):

Best Contact Number:

Mother/Legal Guardian Name (Last, First):

Best Contact Number:

Primary Emergency Contact and phone number:

Please list any physical or other limitations that might hinder your childs participation:

In addition to the parents/legal guardians, I authorize the following people to pick up my child(ren) and/or be contacted in an emergency if the parent/legal guardian cannot be contacted. Include full name, relationship, home and cell numbers.

I authorize KE KULA MELE HAWAII O AKAKA to use the name and any video/photography/audio taken of my participant and/or myself at any time or in any manner in connection with its advertising, publicity and public relations programs. KE KULA MELE HAWAII O AKAKA may only use the video/photographs/audio and will not sell it to any 3rd parties or allow its use in any manner other than specified above. I will make no further claims. *

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I read, understand and accept the policies of Ke Kula Mele (POLICIES button located on left sidebar) *

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Course: *

Voice part:

Technique Level on Instrument *

Music Theory Background (1=None 10=Knowledgeable): *

Knowledge of Chords on Instrument. (1=None 10=Advanced): *

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