SUM-02
Summer Program Selection: Lower School
2
for Hanalani Schools
0
1
7
Student Information
Student Legal Last, First Name
Grade Entering Fall 2017
Summer Program Options
KA IMI LOA (Grades K3–3)
STUDENT CARE SERVICES (Grades K3–6)
 Ka Imi Loa: Grades K3–3 Summer Explorations . ... $1,225
 Before-School Care ... .............. .. .. .. ... .. . .. .. . $165
KA IMI LOA (Grades 4–6)
 After-School Care ... ... ..................... . .. . .. . $390
This program is a customizable package, with options for each period.
Select one option for each of the four periods.
Space is limited and will be on a first-come, first-served basis.
 Ka Imi Loa: Grade 4 Summer Explorations ....... $1,225
Period 1 (8:45 - 9:45am)
Period 3 (11:55am - 12:55pm)
 Math & Robots 4A
 Rad Reading 4B
 Great Outdoors 4
 Ukulele 4
Period 2 (10:00 - 11:00am)
Period 4 (1:00 - 2:00pm)
 Rad Reading 4A
 Math & Robots 4B
 Let’s Cook 4
 Let’s Create 4
 Ka Imi Loa: Grade 5 Summer Explorations ....... $1,225
Period 1 (8:45 - 9:45am)
Period 3 (11:55am - 12:55pm)
 Math Madness 5
 Science Olympics 5
Period 2 (10:00 - 11:00am)
 Reading & Writing 5
 Webmasters 5
 Design Thinking 5
 Robotics 5
Period 4 (1:00 - 2:00pm)
 Handbells & More 5
 Outdoors & More 5
— 6:15–7:30am
— 2:30–5:30pm
INTERSESSION 2 (Grades K3–6)
Intersession 2 for Lower School (Summer 2017) is only
available for current Hanalani students.
 Intersession 2 (INT2) ... ... .................. . . .. .. . . $195
 INT2 Before-School Care .................................... $25
 INT2 After-School Care ...................................... $55
TRANSPORTATION (Grades K3–6)
 One-Way: Mililani/Waipio .................... . . . . . . . . $160
 Pick-Up
 Drop-Off
 Both-Ways: Mililani/Waipio .................. . . . . . . . . $320
 Ka Imi Loa: Grade 6 Summer Explorations ....... $1,225
Period 1 (8:45 - 9:45am)
Period 3 (11:55am - 12:55pm)
 Ceramics 6
 Athletics 6
 Literature 6
 Digital Creations & More 6
Period 2 (10:00 - 11:00am)
 Math 6
 Science 6
Period 4 (1:00 - 2:00pm)
 Foreign Food Fun 6
 Raging Robotics 6
Payment Plan & Billing Total
PAYMENT OPTIONS
 One-Time Payment
— 100% of school bill due at time of registration
 Two-Time Payment
— 50% of school bill due at time of registration
— Remaining 50% of school bill due on or before May 30, 2017
BILLING TOTAL
Program Selection:
Student Care Services:
Intersession 2:
Transportation:
Administrative Fee (non-current students):
___________________
___________________
___________________
___________________
.......................$6.00
Grand Total: _____________________
Visit us online at www.hanalani.org
P: (808) 625-0737 ext. 450 (Grades K3–1), 451 (Grades 2–6), 452 (Grades 7–12)
Page 2
SUM-02
Summer Program Selection: Lower School
2017-2018
for Hanalani Schools
Payment Policies
I, the undersigned parent/legal guardian, understand and will adhere to the following:
— All payments and fees are processed through SMART Tuition.
— An administrative fee of $6.00 will be charged to each applicant who is not a current Hanalani student.
— All cancellation of services prior to 05/30/17 will result in a $60.00 service fee.
— After 05/30/17, tuition and fees for Summer and Intersession programs are non-refundable.
— Failure to submit full payment by 05/30/17 will result in the loss of seat for the summer program.
________________________
Parent/Legal Guardian Initials
Permission for Participation
I, the undersigned parent/legal guardian, understand and will adhere to the following:
— I hereby grant permission for my child/ward (below) to participate in all summer program activities (field trips, hikes, water activities,
etc.).
— Assuming the school observes the necessary safety precautions, I will not hold Hanalani Schools, nor any of its staff members or
parent volunteers, responsible or liable for any injury to my child.
— I understand that my child/ward must be covered by appropriate insurance before he/she can participate in any summer program
activity.
— I agree that photos and videos of my child/ward, as well as his/her artwork, writing samples, and other school work, may be
reproduced in Hanalani brochures, advertisements, electronic publications, print and web media including website, email, and social
media (i.e. Facebook, YouTube, etc.), or any other published materials.
Student Name
Parent/Legal Guardian Signature
Medical Insurance Provider
Print Name
Visit us online at www.hanalani.org
P: (808) 625-0737 ext. 450 (Grades K3–1), 451 (Grades 2–6), 452 (Grades 7–12)
Date
030217