OFFICIAL REGISTRATION FORM - 2023 Summer Learning Hub Registration
Aloha Parents/Guardians,

You are receiving access to this online form because your school has invited your child to participate in this free Summer Learning Hub @ Koko Head Elementary School this summer.

THE DEADLINE TO RESPOND TO THIS REGISTRATION FORM IS SPECIFIED ON THE HARDCOPY LETTER that you received from our school  If we do not hear back from you by then, we may offer your child's slot to another student.

The Summer Learning Hub program is 19 instructional days:
Monday, June 5 - Friday, June 30  (Note Monday, June 12 is Kamehameha Day Holiday)

Summer Childcare Programs (From 12:00-5:30PM):
A third party provider, Kama`aina Kids, will provide childcare on our campus for students participating in the Summer Learning Hub pending sufficient enrollment. More information on this program is forthcoming.

Koko Head School Office

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Email *
Student's Last Name *
Student's First Name *
First and Last Name of the Individual filling out this form *
Current Grade  *
Will your child participate in our Summer Learning Hub?   *
Parent/Guardian #1 First and Last Name *
Parent/Guardian #1 Phone XXX-XXX-XXXX *
Parent/Guardian #1 Email Address *
(OPTIONAL) Parent/Guardian #2 First & Last Name 
(OPTIONAL) Parent/Guardian #2 Phone XXX-XXX-XXXX 
(OPTIONAL) Parent/Guardian #2 Email Address

In case of an accident or serious illness, we need to contact parents/guardians and we are unable to contact parents/guardians, we will contact the emergency contact below. If the school is unable to parents/guardians, I hereby give the school permission to call the physician indicated below and to follow the physician's instructions. If the school is unable to contact the physician, or it is deemed an emergency, the school may make appropriate arrangements which may include the calling of 911 for an ambulance.

Emergency Contact #1 Name & Relationship  
Emergency Contact #1 Phone XXX-XXX-XXXX *
(OPTIONAL) Emergency Contact #2 Name & Relationship 
(OPTIONAL) Emergency Contact #2 Phone XXX-XXX-XXXX 
Physician Name *
Physician Phone Number *
Allergies that require medication (write NA if none) *
Other Health Conditions  (write NA if none) *
Summer Childcare Programs:  Are you interested in a Kama`aina Kids' Summer program that provides childcare services for our Summer Learning Hub students from 12:00-5:30PM on our campus? *
(OPTIONAL) Is there any information that you want your child's Summer Learning Hub teacher to know about your child?  Please also include any dates of pre-planned absences that your child's teachers should be aware of.
A copy of your responses will be emailed to the address you provided.
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