2023 Keiki Summer Program Sign Up Form Parent's Name*Address* Street Address City State / Province / Region ZIP / Postal Code Cell Phone*Parent Email* Student Information1st Child's Name*Grade Completed*Please select the number of weeks that you want to sign up for child 1*7 weeks6 weeks5 weeks4 weeks3 weeks2 weeks1 weekPlease sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. 7 Weeks Discount Price: -$100.00 Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. 6 Weeks Discount Price: -$40.00 Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. 5 Weeks Discount Price: -$40.00 Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. 4 Weeks Discount Price: -$40.00 Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. I will need Morning Care for my child from 6:00am - 8:00am*yesnoI will need Afterschool Care for my child from 3pm - 5:30pm daily*yesnoAdd another child?*yesnoStudent Information2nd Child's Name*Grade Completed*Please select the number of weeks that you want to sign up for child 2*7 weeks6 weeks5 weeks4 weeks3 weeks2 weeks1 weekPlease sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. 7 Weeks Discount Price: -$100.00 Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. 6 Weeks Discount Price: -$40.00 Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. 5 Weeks Discount Price: -$40.00 Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. 4 Weeks Discount Price: -$40.00 Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. Please sign up the above named student for the following weeks* Week 1: Jun5-9 Week 2: Jun13-16 Week 3: Jun19-23 Week 4: Jun26-30 Week 5: Jul3-7 Week 6: Jul10-14 Week 7: July 17-21 Summer Plus fees: AM care only: $10.00 per day PM care only: $10.00 Per day Students may be dropped off at 7:45am daily. No school on June 12 and July 4. Total $0.00 Payment Please remit half of total fees with registration form on or before May 26. The remainder of the balance owed is due on the first day of your child's summer session. Enrollment cannot be guaranteed for registration forms received without payment. No Refunds will be given once program begins. Mail or drop off forms with payment to: Ho`ala School 1067 A California Ave., Wahiawa, HI 96786Signature*Date* Date Format: MM slash DD slash YYYY
