Fillable Kam Maui (Kama'aina Kids)

Fill Online, Printable, Fillable, Blank Kam Maui (Kama'aina Kids) Form

Use Fill to complete blank online KAMA'AINA KIDS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Kam Maui (Kama'aina Kids)

On average this form takes 23 minutes to complete

The Kam Maui (Kama'aina Kids) form is 2 pages long and contains:

  • 0 signatures
  • 20 check-boxes
  • 82 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Kama'aina Kids forms online.

BROWSE KAMA'AINA KIDS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
$5 $85 $5 $75
Gender D.O.B Grade Room#
Gender D.O.B Grade Room#
3
8
*Please return all copies to our Main Office
Pick Up
Late Bus
*Daily rate (9 days or less only)
*Daily rate (9 days or less only)
Late Bus
Pick up
I hereby authorize Kama‘aina Kids and its employees to exercise these discipline policies in regard to my child.
Signature of Releasor
Date
SPONSOR
I hereby agree that, if Kama‘aina Kids staff is unable to contact me or one of the persons listed as emergency contact, I hereby consent that if my child exhibits signs of illness or injur, that at the discretion of the Kama‘aina Kids supervisor on duty, my child
may be taken to the nearest medical facility and be given any examination or treatment that is deemed necessary by the personnel of the medical facility and, if permissible by medical facility, subse-quently released to Kama‘aina Kids Supervisor or staff-in-
charge.
I hereby authorize Kama‘aina Kids to use my child’s name and video or photograph at any time and in any manner in connection with its advertising, publicity, and public relations programs. The video-photo may only be used by Kama‘aina Kids. No further
claims will be made by me.
I hereby give my child permission to attend and participate in the activities conducted by Kama‘aina Kids’ program. These activities include aquatics, off-property excursions, van transportation, and enrichment activities.
DISCIPLINE
Discipline is used to assure the safety and well being of all program participants. All children are expected to respect themselves, other people and their property. If a child is not following the guidelines of Kama‘aina Kids staff consistent with these
expectations, then the child will take a time out from the activity at the staff memb’s discretion. A child with consistent behavior problems will be sent to Kama‘aina Kids’ Program Site Coordinator who may contact the parents for the purpose of removing
the child from the program. Kama‘aina Kids reserves the right to refuse any child’s future participation in its programs.
Name
HDL #
Cell
Authorized Pick-Up & Emergency People (Other than parent / legal guardians):
$30 Return Check Fee ∙ $5 Late Pick-Up Fee ∙
$15 Late Payment Fee
7
Medical Insurance
Policy #
Kama‘aina Kids is an equal opportunity organization and does not
deny enrollment or discriminate on the grounds of race, color,
religion, sex, or national origin. Eligibility to participate in this
program is reliant upon verification of a child’s ability to function
safely in a 1:15 ratio.
Name
HDL #
Cell
Doctor Address
City
6
Doctors Name
Phone
State
Zip
5
Medical Conditions/Allergies
Child 1:
Child 2:
4
Mailing Address
City
State
Zip
Parents Name
Email Address
HDL #
Work Phone
Cell Phone
Parents Name
Email Address
HDL #
Work Phone
Cell Phone
Parents / Legal Guardians (AUTHORIZED TO PICK UP CHILD)
Last Name
First Name
Last Name
First Name
2
Child:
1
Child:
Registration Form
Questions? Call 808-478-4672 or 808-262-4538
2020-2021 Kamehameha - Maui After School Program
Hours: End of School - 5:30 pm
Daily*
Gr K-5
Monthly
Gr K-5
Daily*
Gr 6-8
Monthly
Gr 6-8
Please check applicable boxes & fill out blank spaces.
Child Care Options & Rates
2020-2021 Automatic Tuition Payments (ATP) Authorization Form
We are excited to offer the safety, convenience and ease of Tuition Express® – a
payment processing system that allows secure, on-time tuition and fee payments to
be made from either your bank account or credit card.
Payments will be processed beginning with the first business day of each month.
An email address is required to access receipts online at www.MyProcare.com. 
Credit union members: please contact your credit union to verify account and routing numbers for automatic payments.
Payee Info
Payer Last Name
Payer First Name
Phone (required)
Email Address (required)
Child Last Name
Child First Name
Monthly Tuition
Morning Care
After Care
Total
1.
$
$
$
2.
$
$
$
3.
$
$
$
ATP Start Month
School Name
Total Monthly Tuition
$
Payment Option A (Credit Card)
❑ Visa ❑ Mastercard ❑ American Express ❑ Discover
Cardholder Name
Credit Card Number
Exp. Date
CVV#
Billing Address
City
State
Zip
Payment Option B (Bank Account)
❑ Checking ❑ Savings
Bank or Credit Union Name
Bank or Credit Union Address
Routing Transit Number (see sample below)
Account Number (see sample below)
Please note that in addition to the monthly tuition charge, the following fees shall be assessed:
• There shall be a $20 one-time processing fee assessed per family for each school year.
• There shall be a $30 service charge assessed for any returned checks.
I hereby authorize Kama`āina Kids to initiate credit card charges to the above-referenced credit card account (Payment Option A) OR,
initiate debit entries to my checking or savings account, indicated above (Payment Option B). I am required to give 10 days written
notice to cancel this authorization.
Donation
Kama`āina Kids is a not-for-profit organization. Should you wish to make a tax-
deductible donation to assist our financial aid and scholarship program, please indicate
your donation frequency and amount here:
Frequency:
❑ One-time
❑ Monthly
Donation
$
Print Name
Authorized Signature
Date
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Kam Maui (Kama'aina Kids)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 June 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document