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Home
About CHQR
Features
The Evolution
Encryption
Contact us
My account
Interisland Form
Register/Login
Costco
Costco Greeter
User Costco CHQR-ID
Happe
Shop
Store Manager
Vendor Registration
Happe State Database
Cart
Checkout
My account
Register
Vendor Membership
Vendor Registration
Traveler First Name:
Required, Not displayed publicly
Traveler Middle Name or Initial:
Optional, Not displayed publicly
Traveler Last Name:
Required, Not displayed publicly
Traveler Birthdate: Month-Day-Year
Required, Not displayed publicly
Gender:
------ select an option ------
Male
Female
Rather Not Say
Required, Not displayed publicly
Primary Contact Telephone in Hawaii:
Required, Not displayed publicly
Secondary Contact Telephone in Hawaii:
Required, Not displayed publicly
Email Address:
Required, Not displayed publicly
Traveler Home Address:
Required, Not displayed publicly
Traveler City:
Required, Not displayed publicly
Traveler State:
Required, Not displayed publicly
Traveler Zip Code/Postal Code:
Required, Not displayed publicly
Race and Ethnicity(Select best option)
------ select an option ------
White
Black or African American
Asian
American Indian and Alaska Native
Native Hawaiian
Other Pacific Islander
Other
N/A
Required, Not displayed publicly
Government ID Type:
------ select an option ------
Passport
Drivers License
Passport/Visa
State ID
Other
Required, Not displayed publicly
Government ID Number:
Required, Not displayed publicly
Purpose of Visit to Maui County:
------ select an option ------
Vacation
Returning Resident
Visiting Family/Friends
Business
Relocate to Hawaii
Medical
Accompanying a Minor
Other
Required, Not displayed publicly
Where are you staying in Maui County? Provide address:
Required, Not displayed publicly
Where are you working in Maui? Provide address or description of location:
Required, Not displayed publicly
Are you traveling with accompanying minors?
------ select an option ------
Yes
No
Required, Not displayed publicly
If yes, for children 17 years and younger traveling with a parent/guardian please fill out first name and last name of accompanying minor(s). If not applicable, fill out N/A:
Required, Not displayed publicly
Is this form being filled out on behalf of an unaccompanied minor?
------ select an option ------
Yes
No
Required, Not displayed publicly
If yes, provide the name(s) of the adult(s) with whom the unaccompanied minor will be residing or visiting. If not applicable, fill out N/A:
Required, Not displayed publicly
If yes, provide the phone number(s) of the adult(s) with whom the unaccompanied minor will be residing or visiting. If not applicable, fill out N/A:
Required, Not displayed publicly
Have you signed a 14 day quarantine order?
------ select an option ------
Yes
No
Required, Not displayed publicly
Quarantine Start Date, if not applicable, fill N/A
Required, Not displayed publicly
Quarantine End Date, if not applicable, fill N/A
Required, Not displayed publicly
Travel Information: Arriving in Maui County Airline or Vessel:
------ select an option ------
Hawaiian Airlines
Mokulele
Southwest Airlines
Expeditions
Other
N/A
Required, Not displayed publicly
Travel Information: Arriving in Maui County Airline Flight Number:
Required, Not displayed publicly
Travel Information: Arriving in Maui County Flight or Vessel Date and Time:
Required, Not displayed publicly
Travel Information: Departing from Maui County Airline or Vessel, if applicable:
------ select an option ------
Hawaiian Airlines
Mokulele
Southwest Airlines
Expeditions
Other
N/A
Optional, Not displayed publicly
Travel Information: Departing from Maui County Flight Number, if applicable:
Optional, Not displayed publicly
Travel Information: Departing from Maui County Flight or Vessel Date and Time, if applicable:
Optional, Not displayed publicly
What industry do you work in?
Optional, Not displayed publicly
What is your occupation:
Optional, Not displayed publicly
Limited Quarantine – If you have received approval for a limited quarantine, indicate the record number that was provided to you.
Optional, Not displayed publicly
Submit
