Student Application for Hawaiian Style Summer Fun

Student Registration Form

Student's Name:
Last, First Middle Initial

Address:
Home #: email: Does Student have a cell? Y or N Student's Cell: Will the cell phone be with the student, here at 'Ohana Health? Y or N Age: Birthdate: Circle One: Male or Female
Does the student have any friends or siblings applying for Summer Fun at 'Ohana Health?

Y or N

If yes, List Names:

Name Name

Phone Phone

Relationship to student Relationship to student

Circle the SESSION(S) you are registering for: You may register for any or all sessions now.

Session 1 Session 2 Session 3

6/3 - 6/28 7/1 - 7/26 7/29-8/14 (No Class 7/4-7/5)

Fill in the days and times of the first week you're registering for: Monday
Date: Arrival Time
Departure Time

Tuesday

Wed

Thursday

Friday

Additional Fees for Extra Care (AM and PM).

Student requires Early Care between 7-7:45AM? Student requires After Care between 5-5:45PM?

Y Y

or N or N

Warning: If you can't pick-up your child BEFORE 5:45PM, this program isn't for your family. We start evening classes at 6:00PM and need time to prepare the classrooms.

Parents note your questions and concerns here and use the back if necessary.

Signature of Parent: X

Date: