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					                               HEARTS
                       Hawai’i Education of the ARTS
                            Registration Form


Name:_______________________________________________Age:___Birth Date:_________

School______________________________________________T-Shirt Size_______Grade____

Mailing Address:__________________________________City:______________Zip:_______

Legal parent(s) or guardian:______________________________________________________

Mother:__________________________________Day phone:__________Other:____________

Father:___________________________________Day phone:__________Other:____________

E-mail:_______________________________________________________________________

What is the best way to contact you? (Circle one) Email   This Phone #_________ Mail

In an emergency call:__________________________________Phone:____________________

Insurance:______________________________________Policy#:_________________________

Doctor’s name:_________________________________________Phone___________________

Please check all that apply:

____ HEARTS Boy Choir $100/semester (or $40/month for 3 months) plus uniform

____ HEARTS Girl Choir $100/semester (or $40/month for 3 months) plus uniform

____ HEARTS Musical Theatre Troupe $150/semester (or $60/month for 3 months)

____ I am applying for a Scholarship.       Scholarship Application is attached.


Signature:_____________________________________Print Name________________________

Write check payable to HEARTS. Credit card payments accepted at the FIRST rehearsal.

Matching funds are available for partial scholarships through the Marvin Shelby Memorial
Scholarship Fund and the Mathew Ui Memorial Scholarship Fund. HEARTS is a 501(c)3 non-profit
arts education organization.
        More information at www.heartshawaii.org or call Pamela DeBoard at 741-2787.

                    Every Child Deserves an Arts Education!

				
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posted:4/19/2010
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