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Keiki Impacted by Wildfires 24-25

Aloha, thank you for taking the time to fill out this registration form.  Some examples of services/support we are providing are:  immediate needs, basic needs, assistance with acquiring important documents that were lost in the disaster, food, educational planning and tutoring for keiki, extra-curricular classes in art, culture, and fishing, and monthly 'ohana fun days.  We are also helping with keiki aftercare which could be many things depending on what your keiki needs. 

Contact Information


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Background information

Maui Hui Malama is grant funded and requires us to ask this question.
Maui Hui Malama is grant funded and requires us to ask this question.
Maui Hui Malama is grant funded and requires us to ask this question. My keiki receives
Please select all that apply based on these options
Please select all that apply based on these options


Please let us know how your keiki was impacted by the wildfires. In our intake we will ask for verification like mail with your name and address from wildfire-affected area, keiki report card from school, pay stub for parent who worked in wildfire-affected area, etc. All verification documents must show a date around August 8th, name of child or parent, and name of address/work/school, etc. from the wildfire affected area. If you need help with this question, please call Daisha at (808)830-6096 or email daisha@mauihui.org.




Agreements

I hereby release, hold harmless, and indemnify Maui Hui Malama, its Board of Directors, employees and staff, from and against all claims, including but not limited to claims for property damage and/or personal injuries arising out of my child’s participation in MHM’s group, activities, or the rendering of any medical treatment. I understand that MHM will make reasonable attempts to notify me or the emergency contact as soon as possible in the event of illness or injury to my child to obtain authorization to administer necessary medical treatment. I further give consent to MHM to secure and authorize such medical treatment if MHM is unable to speak with me or the emergency contact for the above named child while under this supervision. I also agree to pay all costs and fees contingent upon receiving emergency medical care or treatment as secured or authorized under this content.
I hereby release, hold harmless, and indemnify Maui Hui Malama, its Board of Directors, employees and staff, from and against all claims, including but not limited to claims for property damage and/or personal injuries arising out of my child’s participation in MHM’s group, activities, or the rendering of any medical treatment. I understand that MHM will make reasonable attempts to notify me or the emergency contact as soon as possible in the event of illness or injury to my child to obtain authorization to administer necessary medical treatment. I further give consent to MHM to secure and authorize such medical treatment if MHM is unable to speak with me or the emergency contact for the above named child while under this supervision. I also agree to pay all costs and fees contingent upon receiving emergency medical care or treatment as secured or authorized under this content.
By checking here I agree to receive emails, mail, and phone calls on information regarding this program as well as other information related to Department of Education, any school, and any educational entity and Maui Hui Malama
I confirm I am the legal guardian of the participant listed above or 18 years or older.