Registration Of Minor For Entertainment
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Registration Of Minor For Entertainment Form. This is a Hawaii form and can be use in Maui Local County.
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Tags: Registration Of Minor For Entertainment, DLC-024, Hawaii Local County, Maui
DEPARTMENT OF LIQUOR CONTROL, COUNTY OF MAUI
2145 KAOHU STREET, ROOM 105, WAILUKU, MAUI, HAWAII
REGISTRATION OF MINOR FOR ENTERTAINMENT
WARNING: A minor shall NOT be permitted to entertain until this registration is completed, approved by the Director and
the minor has obtained a minor registration card for the specific licensed premises. Minor shall NOT perform any
entertainment that is prohibited by law and in an occupation declared hazardous.
EMPLOYER TO COMPLETE THIS SECTION
(Please Print or Type)
1.
Last name, First name, Middle name of Minor
2.
Social Security Number
Date of Birth
Age
Sex
3.
Home Address of Minor
Apt. #
City & State
Zip Code
4.
Name of Chaperon (for persons under 18 years of age only)
5.
Signature of Minor
Dept. of Labor Certification Number (under 18 years of age)
Licensed Premises (Trade Name):
CONDITIONS GOVERNING CONDUCT OF MINOR:
1.
2.
Minor permitted to entertain shall be closely supervised at all times.
Such minor shall not be permitted in the prohibited areas of a licensed premises.
Date
Signature of CORPORATE OFFICER or AUTHORIZED AGENT
Print Name/Title
FOR ENTERTAINERS 17 YEARS OF AGE, OR YOUNGER, LEGAL PARENT OR GUARDIAN MUST COMPLETE THIS
SECTION AT TIME OF INTERVIEW WITH INVESTIGATOR:
This request for the above named minor to entertain at a liquor licensed premises is made with my knowledge and consent.
Signature of Parent or Legal Guardian
Business Telephone Number
Print Name
Home Telephone Number
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DLC-024 [rev 06/03]
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