KAUA’I MOKIHANA FESTIVAL
Consent Form



I, ______________________________________________ , hereby consent that any
(print full name)

motion pictures, sound recordings, still photographs, and video tapes taken of me by the

KAUA’I MOKIHANA FESTIVAL, or its assignee, suppliers or any reproductions of

same may be used by the KAUA’I MOKIHANA FESTIVAL or their assignee, for the

purpose of advertising, illustration, publication, cablecast or broadcast for public service

information and non-profit purposes. I have read and agree to all rules and regulations.


Date-

Signature-

Email-

Phone-

Mailing Address-

If Under 21, signature of Parent or Guardian-

Agency (if appropriate)-


Mail completed form with application by deadline to:
Mālie Foundation, ATTN: Kaua`i Mokihana Festival P.O. Box 13, Kapa`a, HI 96746
Contact: Nathan Kalama 808-822-2166 email: KMFKauai@hawaii.rr.com

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