Nā Kūpuna Makamae Center
Membership Application
First Name *
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Last Name *
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Birthdate *
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Local Phone Number *
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Email
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2nd Member - Last Name
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2nd Member - First Name
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2nd Member - Birthdate
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Membership (select one) *
Member Release - (Classes, Activities, and Excursion)
I/We understand there are dangers and hazards inherent in classes, activities, field trips and during transportation from Nā Kūpuna Makamae to outside activities and return. I/We do agree to assume all risks and responsibilities surrounding my/our participation in such activities, including (without limitation) starting from the date of my membership. I/We contend to be physically capable to participate in any/all activities that I/we attend.

I/We also agree to assume all risks and responsibilities surrounding my/our participation in any activities undertaken, as an adjunct thereto. Further, l/we, do for myself/ourselves, my/our heirs and personal representative(s) hereby agree to INDEMNIFY, DEFEND, HOLD HARMLESS, RELEASE and FOREVER DISCHARGE Nā Kūpuna Makamae, a non-profit corporation, and all its officers, Board of Directors, agents, employees and instructors from and against, any and all claims, costs, attorney fees, liabilities, demands and actions, or causes of action; or any kind by nature, on account of damage to personal property, personal injury or death, which may result from participation from such activities, without regard to the fault or negligence, if any, of Nā Kūpuna Makamae, its officers, agents, employees, and instructors, during my/our participation in such activities.

IN WITNESS WHEREOF,
I/WE having read this document and fully understand its contents and consequences have caused this RELEASE to be executed this (please fill out the blanks, example "this ____23____day of___Sept__, __2016__").
__________________day of ______________, ________ *
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Permission for Press / Photo Release
OCCASIONALLY, Nā Kūpuna Makamae has photos of its members, and Nā Kūpuna Makamae will use these photos for publicity (television, newspaper, magazine, publications, brochures, newsletters, social media, etc.). In such situations, it is the policy of Nā Kūpuna Makamae to seek permission before using the photos. By signing below, I/we hereby give my/our permission to have Nā Kūpuna Makamae use my/our photo or voice for media use without compensation.
Signature of Applicant (please enter your full name)
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Date
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