KEIKI/YOUTH STUDENT APPLICATION & RELEASE FORM Logo
  • KEIKI/YOUTH STUDENT APPLICATION & RELEASE FORM

    Complete one form PER FAMILY.
  • Keiki/Youth Mixed Media (primarily ceramics) classes are held every Saturday. There are two sessions to choose from. 9:45am-10:45am OR 11:00am-12:00pm

    Youth 13+ may attend the following adult classes:

    Painting with CJ Caberto Thursdays 9am - 12pm

    Ceramics with Misty Mollena (previous experience required) Fridays 3pm - 6pm

    Ceramics with Dan Bennett Saturdays 1pm - 4pm

    See calendar molokaiartscenter.org/calendar for current class schedule. If class is cancelled, it will be noted on the calendar. Please check calendar before heading to class.

    *Supplies partially funded by Friendly Isle United Fund.

  •  -
  • If you would like to become an Annual Member first, please go to https://form.jotform.com/molokaiartscenter/annual-member-form then return to this form.

     

  • Child(ren)'s Information

    Complete a separate application if more than 5 children in the household.
  •  - -

  • American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
    Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
    Black or African American: A personnel having origins in any of the black racial groups of Africa.
    Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
    White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

  •  - -

  •  - -

  •  - -

  •  - -

  • Parent/Guardian Information

    For Organization, use main contact as Adult 1

  • If there is no 2nd Parent/Guardian, please list an additional contact in case of emergency.


  • Liability Release Form

  • All activities involved in making art and/or ceramics include some minor health hazards which we will attempt to minimize, including but not limited to inhalation of minute amounts of clay dust and exposure to raw glaze materials for advanced and intermediate students.

    I understand that participation in the above activity or event may be hazardous for the above-named participant(s).

    In signing below,

    • I have read and will abide by current studio use protocols.
    • I assume that injury risk or harm that may occur to the participant(s) listed above as a result of participating in the Molokai Arts Center events or activities. *note special circumstance/handicap next to person's name for reasonable accomodation*
    • I hereby release the Molokai Arts Center and its officers and board members or agents from any liability, costs and damages resulting from participating by the above-named individual(s).
    • If the participant is a minor, I agree that the minor has my consent to participate in the event or activity.
    • I also give my consent for the Molokai Arts Center to seek emergency treatment for myself or the minor if necessary, and I agree to accept the financial responsibility for the costs related to the emergency treatment.
    • I hereby authorize the Molokai Arts Center to publish photographs of above-named participant(s) for use in print, online, and video-based marketing materials as well as MAC publications. I further acknowledge and agree that neither I, the minor child, nor minor children will receive financial compensation for any type for these photos and that publication of said photos confers no rights of ownership or royalties whatsoever.
  • Clear
  •  - -
  • Payment

    If your child(ren) is in a school-sponsored (i. e. 21st Century, HLIP) or organization-sponsored program, please check School/Organization Sponsored and Go to Payment Page to complete registration.
  • If you would like to become a Member first, please go to https://form.jotform.com/molokaiartscenter/annual-member-form then return to this form.

    Donations are always welcome. Please use QR code below or go to MAC 501c3 charitable donation after you Go to Payment Page. Mahalo!

  • Image-84
  • prevnext( X )




                  Item subtotal:$0.00














                  Subtotal $0.00Tax $0.00Total $0.00
                •  
                • Should be Empty: