HURAITI MANA 2018 NEW DANCER REGISTRATION

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E ha'amana ma ma'atou. We invite you to join Huraiti Mana at any experience level. If you're looking for a great workout, a chance to learn Polynesian dances, an opportunity to perform or compete professionally, or all of the above, join us today and learn more through Huraiti Mana.

Please fill out the information below to register for Huraiti Mana combined Tahitian & Hula dance classes for 2018. All are welcome. A confirmation email will be sent including further details regarding Huraiti Mana Dance Classes. If you have any questions in the meantime, please email huraitimana@gmail.com. Mauruuruu roa, thank you so much for your interest in Huraiti Mana!

Please note: NO CLASS September 26 & October 3

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* 1. Dancer's Name

First Name

Last Name

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* 2. Dancer's Date of Birth MM/DD/YYYY

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* 3. Contact Information

Email Address

Phone Number

Mailing Address

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* 4. Guardian's Name (for Dancers under 13 years old)

First Name

Last Name

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* 5. Emergency Contact

First & Last Name

Relationship to Dancer

Best Number to Call

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* 6. Tahitian & Hula Dance Class
_{Registration is still required for all dancers.

First class is free. Monthly subscriptions is $35, due on the first class of each month. Drop-in option for $20 per class. Payments may be accepted in cash or a check written out to "Huraiti Mana."

NO CLASS: September 26 & October 3}

5:30-6:30PM Keiki/Tamari'i (Youth 3 -12 years old) FREE

6:30-7:30PM Adult/Young Adult (13+)

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* 7. Liability Release

^{In consideration for my attendance and participation in physical fitness training offered by Huraiti Mana; I, the student/guardian, acknowledge the existence of certain inherent training risks and hereby agree to release and discharge Huraiti Mana on behalf of myself, my children, my parents, my heirs, assigns, personal representative, and estate as follows:}

^{I further relieve Huraiti Mana, its management, assigned staff, and fellow students from any liability resulting form loss, whether personal belongings or bodily injury.}

^{I also hereby state that myself, or my child, is physically fit to take the prescribed course of instruction and do so of my own free will in exchange for an agreed upon fee.}

^{I understand that there is no refund policy on any monies I will pay Huraiti Mana.}

^{I certify that I have read, understand, and comply to agree with all of the rules and regulations of Huraiti Mana.}

^{By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Huraiti Mana on the basis of any claim which I have released herein.}

^{I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS.}

We/I hereby agree to the terms set by Huraiti Mana as referenced above.

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* 8. Photo/Video Release

^{I grant Huraiti Mana, its Representatives, and Employees the right to take photographs of me, my children, and my property in connection with Huraiti Mana and any/all of its programs, classes, and events. I authorize Huraiti Mana and transferees to Copyright, use, and publish the same in print or electronically. I agree that Huraiti Mana may use such Photographs, as described above, with or without my name and for any lawful purpose, such as Publicity, Illustration, advertising, and web content.}

We/I hereby give permission for Huraiti Mana to use photos as referenced above.

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* 9. Signature_{By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written requests to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.}

We/I hereby agree to the terms set by Huraiti Mana as referenced above.