2010 Camp Leahi Application Form

For more information contact Lionel Barona, Owner/Operator

(808) 371-3823 or lionelbarona@hotmail.com
A nonrefundable deposit of $200 must accompany each application by March 20, 2010
in order for application to be processed. Remaining balances are due by May 15, 2010.
Applications received after March 20th will automatically be WAITLISTED and
considered as a LATE REGISTRATION. Wait listed applicants will NOT be
guaranteed a space. Ten percent (10%) off all tuition if PAID IN FULL.

* Make all checks payable to: Leÿahi Enterprise

* Mail Checks, application, and emergency form to:
Lionel Barona 98-1361 Koaheahe Pl. #112 Pearl City, HI 96782

Child’s/ Children’s name(s): For Special SOS afternoon program check: ______yes
(Special Program for first grade SOS students attending orientation)

1._________________________ age:_____ sex: M or F

date of birth:_______________ school:___________________________ grade in fall:_____
2._________________________ age:_____ sex: M or F
date of birth:_______________ school:___________________________ grade in fall:_____
3._________________________ age:_____ sex: M or F
date of birth:_______________ school:___________________________ grade in fall:_____

Parents’ Names:____________________________________________________________
E-mail Address:____________________________________________________________
Mailing Address:_____________________________________________________________
Mother’s Phone: Home:_______________ Work:_______________ Cell:_______________
Father’s Phone: Home:________________ Work:_______________ Cell:_______________

PLEASE CHECK SERVICES THAT YOU ARE PLANNING TO USE:

_____Regular Session (June 7- July 16) $1000
_____Morning care (7:00-8:00 a.m.) and/or after care (3:00-5:00 p.m.) $275 for 6 weeks
_____Lunch $140 for 6 weeks
_____Extended sessions (July 19- 30)

Camper’s t-shirt size: child’s _____ sm. (6-8) _____med.(10-12) _____Lg.(14-16) _____XL(18-20)
Adult _____M _____L (order one size larger if child does not like fitted shirt)

Advertisement Release:
_____I allow my child’s photograph to be used for future advertising purposes for Camp Leÿahi.
_____I do not allow my child’s photograph to be used for future advertising purposes for
Camp Leÿahi.
Parent Signature:_______________________________________________________
Date
After reviewing an application, the director MAY need to contact parents in order to obtain more
information. The best time to call us would be at ________________________. Camp Leahi reserves the
right to refuse admission to any child whose needs may not be met by the program.