Mālama 21st Program Enrollment Form

Hooray, youʻve been accepted.  Hereʻs the form to provide all the student details for enrollment.

• Parent(s)/Guardian Information

  This section is the basic information we will need to enroll your child in the Mālama program for 2021. Program is Virtual until further notice. View https://thepaf.org/covid for our safety policy. The Malama Koolaupoko Malama Honua 21st CCLC program is specific to 9 public schools in the Windward district on Oahu, Hawaii. If you have not been invited to apply to this program by your school, you are more than welcomed to access all the public information and resources available on this website, you may also apply for other PAF programs, WIRED and the Kilo Kai Marine Science Club for High School students. Mahalo!
• Primary Contact*
  First Last
• Secondary Parent or Legal Guardian (optional)
  First Last
• Phone
  required
• Cell Phone for texts in emergencies or urgent situations*
  required
• Street Address*
  required
• City*
  required
• 5 digit zip code*
  required
• Emergency Contact 1*
  Who should we call / text FIRST in an emergency?
• Emergency Contact 2*
  Who should we call / text SECOND if we canʻt reach person 1 in an emergency?
• Emergency Contact 2
• Additional Adults Who May Pick Children Up from In-Person Activities
  Full Name, Relationship, Phone number One per line please 🙂
• # students*
  Up to three students may apply on one form.
  Please enter a number from 1 to 3.

• Student 1

• Student 1 Legal Name*
  First Last
• Date of Birth*
  Date Format: MM slash DD slash YYYY
• Gender*
• ALLERGIES / Allergic Reactions of Student 1*
  Please describe any allergy / health issue we should be informed of, or write NONE. This is important information for later, when in-person programming resumes.
• Medications Student 1*
  Please inform us of any medications your child currently takes. You may update this at any time by informing your child's teacher, preferably in writing please. Please describe any medications we should be informed of, or write NONE. This is important information for later, when in-person programming resumes.

• Student 2

• Student 2 Legal Name*
  First Last
• Student 2 Date of Birth*
  Date Format: MM slash DD slash YYYY
• Student 2 Gender*
• ALLERGIES /Allergic Reactions of Student 2*
  Type NONE or DESCRIBE in detail, including any emergency instructions for allergic reactions.
• Medications taken by Student 2*

• Student 3

• Student 3 Legal Name*
  First Last
• Student 3 Date of Birth*
  Date Format: MM slash DD slash YYYY
• Student 3 Gender*
• Allergies / Allergic Reactions Student 3*
• Medications taken by Student 3*
• Name
  This field is for validation purposes and should be left unchanged.