Mele Murals Fall Program 2023 Registration

TEF MM LOGOS Aloha! Applications are now being accepted for students in 3rd-5th grade. Open to students interested in learning art through Hawaiian culture, meditation, 'Olelo Hawai'i, and oli. This fall we are requiring a $100 participation fee. Students who qualify for free and reduced lunch will be required to pay a $50 deposit. The deposit can be returned if the student attends all five days of the program.

Space is limited apply today.

All applicants will be notified September 20th if accepted. For more information visit Mele Murals Fall Program | The Estria Foundation

Student Information

Name

First Name

Last Name

Student's Birthdate

(mm/dd/yyyy)

Present School

Current Grade

Age

Is Your Child Hawaiian?

Yes

Is Your Child a returning participant?

Yes

Gender

Female

Male

To best support your child, please tell us if his/her school provides any accommodations that we need to know about to ensure that your child will be successful. List also any special needs.

If none please indicate n/a

Please list any allergies:

If none, please indicate n/a

Please list any medical conditions

If none, please indicate n/a

Please list any medical conditions Copy

If none, please indicate n/a

Family Information

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Parent / Legal Guardian #1

First Name

Last Name

Home/Cell Phone Number

Work Phone Number

Verify Email

Relationship

Parent / Legal Guardian #2

First Name

Last Name

Home / Cell Phone Number

Work Phone Number

Verify Email

Relationship

Emergency Contact Person (other than parent(s) and/or guardian(s)

First Name

Last Name

Relationship

Cell Phone Number

Home Phone Number Copy

Program Participation Fee

Does your child qualify for free or reduced lunch?

Yes - Free Lunch/Reduced Lunch

No - Does not Apply

Amount

$100

$50 - *for students who qualify for free or reduced lunch

Registration Agreement

I/We hereby give permission for my/our child to participate in all activities of the Mele Murals Fall Program expressly and specifically acknowledging that those activities may include meditating, drawing, painting, and field trips. I/We agree to abide by all policies and procedures relating to my/our child’s registration and participation in the Mele Murals Fall Program. I/we understand that by signing this registration form, I/we authorize the Mele Murals and Estria Foundation team to use the names and any video/photograph/audio of my child for public relations or promotional purposes.

I understand and agree to the terms of this registration/agreement

Yes

Parent's / Legal Guardian's Name

First Name

Last Name

Add 3% to my total amount to help cover the payment processing fees