Student Application KAILUA HIGH SCHOOL Mālama 21st Program

Fall 2021 - Spring 2022

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Parent/Guardian Name*
This is the main email address we'll use for your household.
The best number to reach someone in your household. Either the primary parent mobile phone, or a house phone.
Is there a second parent/guardian?
Grade*
Student is entering this grade - Fall 2021
Student Name*
Date of Birth*
Please describe, or write "none"
Please describe, or write "none"
Who do we call first in an emergency? Name and phone number (text number if different)

This section must be completed by the Parent/Guardian if the student is a minor (under 18 years old). If youʻre under 18, and you need to save this application and come back later with your parent/guardian, scroll to the bottom and click SAVE and Continue Later.

Consent Form: Section 1*
Consent Form: Section 2*
Consent Form: Section 3*
Signature*