Spring Break | PC Afterschool Hula

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◆ FALL 2024 registration is FULL ◆ Ho'ike videos & 3rd Place for Best Parade Marching Unit pics now in gallery

Spring Break is
March 18-22

Registration is closed

REGISTRATION FORM for SPRING BREAK 2024 PROGRAM
for regular school year after school program registration, go here

Student Last Name

Student First Name

Grade (K-6)

FULL DAY 7:30a-5:30p: $30 / DAY

AM HALF DAY 7:30a-12:30p: $15 / DAY

PM HALF DAY 12:30p-5:30p: $15 / DAY

REGISTRATION IS NOW CLOSED

We are now FULL. Our next intersession program will be in Fall Break 2024 (registration will begin in September)! Have a great spring break, everyone!

Monday 3/18 - ALL SLOTS FULL

Full Day | AM Half Day | PM Half Day

Tuesday 3/19 - ALL SLOTS FULL

Full Day | AM Half Day | PM Half Day

Wednesday 3/20- ALL SLOTS FULL

Full Day | AM Half Day | PM Half Day

Thursday 3/21- ALL SLOTS FULL

Full Day | AM Half Day | PM Half Day

Friday 3/22- ALL SLOTS FULL

Full Day | AM Half Day | PM Half Day

WEEK-LONG, ALL-DAY PROGRAM

Along with daily hula, we'll be doing daily arts & crafts (e.g. making slime, paper mache projects, etc.), science (e.g. growing crystals, lava lamps, etc.), indoor games/outdoor play, and cooking. We'll also have feature activities, including:

- One off-site field trip where the kids will ride and get a special guided tour of the Skyline Rail with a cultural liaison from the Dept of Transportation, and learn the place-based oli written for the rail route as well as cool local history and Hawaiian folklore of the different areas.

- One day of CPR & first aid training for kids provided by Kids4CPR and awesome medical volunteers from our community.

- One water morning on campus followed by a swimming afternoon at the Pearl City Rec pool, which has both a swimming & wading pool.

- One "reuse fun" day with makerspace stations where kids can upcycle everyday items from home to make fun new creations (e.g. the viral trend of pet toys made from t-shirts), DIY kaleidoscopes, and more.

- One special project day where the kids will make a gift for their parents (so you'll have to wait and see what they make for you!).

This fee covers the cost of daily project activities, art/science materials, cooking ingredients, field trip/speaker expenses, etc.

Lunch add-on for $2.50 / day *

Yes, I'd like to add-on lunch. Please email me to confirm which days.

No, I don't need to add-on lunch. I will pack home lunch for my child.

Note: This lunch add-on is separate from and unrelated to what the kids will be doing in our daily cooking activities, which will be things like baking yeast bread, churning ice cream from scratch, making pasta recipes, etc.

OTHER IMPORTANT INFO:

Drop-Off / Pick-Up (at Rm 21): You can drop your child off as early as 7:30 am and pick up as late as 5:30 pm.
The main activities will happen between 8 am to 4 pm. Indoor activities will be in Rm 21, hula will be on the outdoor stage (unless it rains, then it will be in the cafeteria), and outdoor fun will be had on the field/playground/court.

Please have your child wear comfortable clothes and shoes (for outdoor play), and pack a home lunch (or add-on lunch above) as well as 2 snacks (one am & one pm), a water bottle, sunscreen, and a pair of slippers/crocs.

Note: Your child doesn't need to be a current student in our daily after school hula program to join the spring break intersession program. We just ask that you contact us beforehand so we can best plan our curriculum / grouped activities.

PARENT/GUARDIAN INFORMATION

Parent/Guardian Last Name

Email

Preferred Method of Contact

Parent/Guardian Last Name

Email

Preferred Method of Contact

Parent/Guardian First Name

Primary Phone #

Secondary Phone #

Parent/Guardian First Name

Primary Phone #

Secondary Phone #

ADDITIONAL INDIVIDUALS AUTHORIZED FOR PICK-UP

I understand that my child will only be released to parents/guardians and pre-authorized individuals.

Name

Relation to student:

Name

Relation to student:

Name

Relation to student:

If you'd like to allow pick-up by individuals not pre-authorized above, please provide a code word they will need. (optional)

Chosen code word if we can't reach you:

EMERGENCY CONTACT INFORMATION

In the event the parents/guardians cannot be reached, who is the next person(s) to contact?

NAME

PHONE

NAME

PHONE

PEDIATRICIAN'S NAME

PHONE

Pediatricians will only be contacted for medical decisions if parents/guardians cannot be reached.

I give my consent for appropriate action to be taken for my child's well-being.

I understand I am financially resposible for ambulance transport and hospital charges incurred on my child's behalf in a warranted medical emergency.

ALLERGIES / MEDICATIONS / MEDICAL CONDITIONS

TERMS & CONDITIONS

ATTENDANCE: I understand that I need to give notice via phone, text, or email if my child will be absent or tardy so the program can adjust accordingly.

ILLNESSES: If my child is noticeably ill (presenting with a fever, Covid symptoms, etc.), I understand that I or my emergency contacts may be asked to take my child home early, for their well-being and that of their peers.

PICK-UP: I understand that I must pick up my child no later than 5:30p, and that I will give notice by phone or text if I will be late. If my child is not picked up by 6:30p, I give consent for my child to be driven to a new safer pick-up location (i.e. nearby open public library or shopping center) if the school lot becomes deserted or otherwise unsafe.

TUITION: I agree to pay the costs for all spring break program days selected before the first day of spring break.

RULES: My child and I understand that it is my child's responsibility to follow all rules, as they are there for their safety as well as that of their peers, and that continued disregard for rules may result in dismissal.

I understand and agree to all the terms & conditions listed above.

WAIVER, RELEASE OF LIABILITY, AND INDEMNITY AGREEMENT

I understand that my child's participation in the activities offered by Pearl City Afterschool Hula, LLC is not without known and unknown risks, and that this agreement applies to all instances of my child's participation.

I understand that Pearl City Afterschool Hula, LLC is in full compliance with all school and state liability insurance requirements, and that they have provided the school with their Certificate(s) of Insurance per state regulations.

I understand and allow for the responsible videotaping and photography of my child engaged in hula and other spring break activities by Pearl City Highlands Elementary and Pearl City Afterschool Hula, LLC for online, digital, print, or social media sharing, without compensation, hereby releasing interest in said media for which I am giving permission.

I understand that the State of Hawaii and Department of Education requires liability waivers and indemnification agreements from the participants of Pearl City Afterschool Hula, LLC's activities that take place on and off Pearl City Highlands Elementary School grounds, as applied to all instances of my child's participation in said activities, as well as any separately related off-campus measures that may be taken in regard to my child's safety or well-being.

Indemnification Statement: The undersigned individual, family members, personal representatives, agents, and successors, for and in consideration of the State of Hawaii Department of Education permitting and allowing the use of the designated school rooms, buildings, and/or facilities jointly and severally agree(s) to indemnify and save harmless the State of Hawaii Department of Education and Pearl City Afterschool Hula, LLC, against any and all loss, liability, demands, claims, suits, action or proceedings of every name, character and description which may be incurred by or brought against the State of Hawaii Department of Education and/or Pearl City Afterschool Hula, LLC for or an account of any injuries or damages to any person or property received or sustained by any person, directly or indirectly, by or in consequence of the participation of said activities and use of the school facilities/grounds.

Electronic Signature (type your first and last name)

I am the child's parent/guardian, authorized to acknowledge and accept all terms on this form.

Acceptance and Acknowledgement

By checking this box, I hereby certify my typed electronic signature and assert my full understanding and agreement to the above statements.

PAYMENT

The spring break program payment will be due in full before the start of the spring break program. Your signature below certifies that you understand and agree to your payment responsibilities.

How will you be paying for the spring break program? *

Please email me an online credit card invoice (via Square® online payments)

Please email me a PayPal invoice

Please email me a Venmo invoice

I will pay by credit card, in person, BEFORE spring break starts

I will pay by check, in person, BEFORE spring break starts

I will pay in cash, in person, BEFORE spring break starts

Parent/Guardian Electronic Signature

Today's Date

Acceptance and Acknowledgement

By checking this box, I hereby certify my typed electronic signature and assert my full understanding and agreement to the above statements.

REGISTRATION IS CLOSED

ALL SLOTS ARE FULL

Daily Lunch Menu (Fixed Entrée):

Mon: Chicken Nuggets w/ Mac & Cheese (and hidden veggies)

Tue: Ham & Cheese Sandwich (plus lettuce/tomato) w/ Tater Tots

Wed: Spam Musubi w/ Edamame

Thu: Hot Dog on a Bun w/ Celery & Veggie Sticks w/ Ranch

Fri: Spaghetti in Veggie-Blended Marinara w/ Cheesy Breadsticks

Daily Choices to go w/ Fixed Entrée:

Drink: Capri Sun or Milk | Veggie: Carrots or Cucumbers w/ ranch

Side: String Cheese or Gogurt | Fruit: Apple or Banana Slices

© 2023-2028 by Pearl City Afterschool Hula, LLC

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