Student Application Lokahi 21st Program

Fall 2021 - Spring 2022

Parent/Guardian Name(Required)
School(Required)
The school your child regularly attends
Grade(Required)
Student is entering this grade - Fall 2021
Student Name(Required)
Date of Birth(Required)
Please describe, or write "none"
Please describe, or write "none"
The primary parent enrolled the child. Is there another parent/guardian we should add to the child's record?
Transportation
Transportation is an issue that would prevent my child from attending the program. Check the box for a staff member to contact you to assist with transportation needs.
Hidden
Dismissal Home from School(Required)
Consent Form: Section 1(Required)
Consent Form: Section 2(Required)
Consent Form: Section 3(Required)
Signature(Required)