Open Enrollment
Learn to Hula
Learn from accomplished Hula Instructor Kumu Pekelo Day. Under his direction the school which began just over 3 years ago, has classes in Eugene and Ashland, Oregon and now in 2012, Tokyo Japan. He has been instructing for over 40 years and brings a wealth of native Hawaiian knowledge to each student.Registration is open to Men, Women & Children of all ages and skill levels. Classes will start on February 6th, at 5:00 pm upstairs in the historic Cox Cannery building, located at the corner of 2nd Avenue & Polk Streets, 1320 W. 2nd Ave, Eugene, OR 97402.
Enrollment
Please submit online, download PDF or print registration form below (by highlighting; copy & paste form into your document program) and bring with you to your first class.
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STUDENT REGISTRATION FORM
Contact Information
Name:
Street Address:
City ST ZIP Code:
Home Phone :
Mobile Phone:
E-Mail Address:
Dance Experience and Background
Describe your Hula experience level
___ NONE, I am
a first time hula student
___ YES, I have
studied Hula ____# of years
Hula Implements
If so, please list which ones you currently own.
______________________ _____________________
______________________ _____________________
______________________ _____________________
______________________ _____________________
Previous Dance Experience
List your very first Kumu and end with your last and/or describe past hula experience.
Medical
Do you have any physical or medical issues we should be aware of?
NO__________ YES__________ If Yes, please describe.
Person to Notify in Case of Emergency
Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address
Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address
Agreement and Signature
By submitting this application, I affirm that the
facts set forth in it are true and complete. I
understand that if I am accepted as a student,
any false statements, omissions, or other
misrepresentations made by me on this
application may result in my immediate
dismissal.
Name (printed)
Signature
Date
Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color,
religion, national origin, gender, sexual preference, age, or disability.
Thank you for completing this application form and for your interest in becoming part of our
Halau.
HALAU LAIBILITY WAIVER-RELEASE FORM
Agreement and Signature
I hereby waive all my liability rights toward Pekelo Day and absolve him from responsibility
for any and all injuries I may incur during classes, from classes, performances or any other
halau function.
I have read the above, understand its contents, and voluntarily agree to its terms.
________________________________________ _______________________
Signature Date
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Halau Hula Na Pua O Hawaii Nei
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(request PDF version emailed to you) (Visit our FAQs page)