HomeMy WebLinkAboutForm - Application for Minor Entertainment Permit (fillable)
DEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI'I
Hilo Lagoon Centre, 101 Aupuni St., Unit 230, Hilo, Hawai'i, 96720 * Phone: (808) 961-8218 * Fax: (808) 961-8684 E-Mail: cohdlc@hawaiicounty.gov
APPLICATION FOR MINOR ENTERTAINMENT PERMIT
Pursuant to Rules 3-2-D-8 of the Rules and Regulations of the Liquor Commission of the County of Hawai‘i,
application is hereby made for a Minor Entertainment Permit.
Date of Function: Time:
Kind of Performance:
Minors, ages 18 to 20 years old: (If large group, attach information)
Name: Birthdate: Address: ____________________
Name: Birthdate: Address: ____________________
Name: Birthdate: Address: ____________________
Minors, ages 17 years and under: (If large group attach information)
Name: Birthdate: Address: ____________________
Name: Birthdate: Address: ____________________
Name: Birthdate: Address: ____________________
The request for a minor entertainer, age 17 years or under, is made with my knowledge and consent. The minor will be under my direct supervision at all times while within the licensed premises and will be escorted to and from the premises by myself or an authorized adult . Parent/Guardian:
(Signature) Name:
Date: Phone No.:
E-Mail:
CERTIFICATION BY LICENSEE
I certify that the information contained herein is true and correct and that I will be held responsible to ensure that minors do not commingle with patrons and that their participation and presence shall comply with the liquor laws.
Licensee:
dba:
By: (Signature)
Name: Title:
Date: Phone No.:
E-Mail: PERMIT Your application for a Minor Entertainment is approved.
By:
Director Date:
Hawai‘i County is an Equal Opportunity Provider and Employer