Navy Hale Keiki Summer School - 2015
For Students Entering PS-Fifth Grade
In the Ocean
Session 1:
June 1 – June 26
Welcome to summer school Session 1
where activities will center in the "ocean.”
Each day will be devoted to language,
math, and art/music lessons. Enriched
academic lessons will be taught within the
context of our theme and will focus on
reading and writing to help students
develop a more extensive vocabulary.
Our academic program strives to
promote personal achievement and will
reinforce our fall school year program.
Students will be able to choose activities
from various centers and who
knows.....there might be a surprise show
at the bottom of the ocean. There will
be emphasis on learning to function in a
group, working independently, accepting
responsibilities, and learning to problem
solve. We will incorporate hands on
learning, discovery, play, and fun! Let's
get swimming in the ocean!
Sincerely,
Jolynn Komoda
Director, Summer School Program
Mozart and Monet
Session 2:
June 29 – July 17
In the second session, students will explore
music and the visual arts. Music has the
power to stimulate the mind, enrich the
heart, and soothe the soul. Students will
have many opportunities to express
themselves through different musical
activities. They will learn basic music
fundamentals while singing, moving, and
listening to music as well have opportunities
to play along with and create music using
rhythm instruments. They will also be
exposed to different musical styles and
learn about famous composers. During
this session, the students will also create
and express themselves through a variety
of art projects. They will learn about
famous artists in history and use different
types of media to create their own
masterpieces. Our academic program will
incorporate reading, writing, listening,
speaking, and math around these content
areas and allow for a positive learning
experience through a hands-on approach
to learning. Let's get creative and have
fun with the arts!
2015 SUMMER SESSION 1 & 2
IMPORTANT ENROLLMENT INFORMATION
IMPORTANT ENROLLMENT AND PAYMENT DATES
March 15, 2015 (ongoing thereafter): Military and Civilian Summer Applications Accepted
May 15, 2015: Summer Session 1 Tuition and Full Time After School Care Fees will be processed through FACTS if applicable.
Refer to the Summer Tuition Agreement for additional payment information.
June 15, 2015: Summer Session 2 Tuition and Full Time After School Care Fees will be processed through FACTS if applicable.
Refer to the Summer Tuition Agreement for additional payment information.
AGE REQUIREMENTS
New students entering Navy Hale Keiki School must meet the following age requirements.
Preschool - 3 years old by 7/31/2015
Prekindergarten - 4 years old by 7/31/2015
Kindergarten - 5 years old by 7/31/2015
DUE AT TIME OF REGISTRATION (NEW AND RETURNING STUDENTS)
Completed NHKS Summer Application and Registration Forms
BOTH PARENTS must sign the Tuition Agreement
Registration Fee ($50.00)
Please be advised that incomplete applications will not be processed.
Students will not be eligible to attend until all applicable forms have been signed and submitted.
DUE BY MAY 15, 2015 (SESSION 1) AND JUNE 15, 2015 (SESSION 2) (NEW STUDENTS)
 Copy of student’s birth certificate
 Student Form 14 Health Record (or equivalent). Physical examination must be performed within 12
months of student’s first day of attendance. If a physical examination cannot be completed prior to the
student’s first day, please provide a statement from your health care facility indicating the date of your
child’s appointment.
 TB skin test performed within 12 months prior to student’s first day of attendance. (A separate sheet is not necessary if your child’s tuberculosis
exam is annotated on Form 14.)




Current immunization record (A separate sheet is not necessary if your child’s immunizations are annotated on Form 14.)
Copy of Power of Attorney (Only if military spouse/sponsor is deployed or unable to sign.)
Copy of Dependant Care Certificate or Family Care Plan (Only for single parent or dual military families.)
Navy Child and Youth Programs Form (New students only.)
DUE BY MAY 15, 2015 (SESSION 1) AND JUNE 15, 2015 (SESSION 2) (RETURNING STUDENTS)
***Returning students do not need to provide birth certificate, annually updated Form 14, TB clearance, or immunization record.***
These documents are only necessary if there are changes in information.
WE ANTICIPATE FULL CLASSES. PLEASE DO NOT DELAY SUBMITTING YOUR APPLICATION.
REGISTRATION IS ACCEPTED ON A FIRST COME, FIRST SERVED BASIS.
NAVY HALE KEIKI SCHOOL
2015 RETURNING STUDENT SUMMER ENROLLMENT FORM
STUDENT NAME:
GRADE LEVEL IN 2015-2016:
SUMMER ENROLLMENT
Please check requested sessions and care options.
Session 1 (June 1 - June 26)
Early Bird Care (Provides care from 6:00 a.m -7:30 a.m.)
Before School Care (Provides care from 7:00 a.m. - 7:30 a.m.)
Full Time After School Care (Provides care Monday - Friday from dismissal - 5:30 p.m.)
Standing Reservation After School Care
(Provides care for up to 3 days a week from dismissal - 5:30 p.m. Please indicate days that you need care.)
MON
TUES
WED
THURS
FRI
Session 2 (June 29 - July 17)
Early Bird Care (Provides care from 6:00 a.m -7:30 a.m.)
Before School Care (Provides care from 7:00 a.m. - 7:30 a.m.)
Full Time After School Care (Provides care Monday - Friday from dismissal - 5:30 p.m.)
Standing Reservation After School Care
(Provides care for up to 3 days a week from dismissal - 5:30 p.m. Please indicate days that you need care.)
MON
TUES
WED
THURS
FRI
HEALTH/MEDICAL INFORMATION
My child receives care for the following medical conditions or allergies:
No medical condition or allergies (Please skip to the next section.)
Yes, my child has the following medical condition(s). (Please check all that apply.):
Asthma
Behavioral Problems
Cancer/Leukemia
Chronic Cough/Wheezing
Diabetes
Heart Problems
Hemophilia
Hypertension
JRA Arthritis
Rheumatic Heart
Sickle Cell Anemia
Vision Problems
Allergies:
Bee Sting
Medications
Hearing Problem
Skin Problems
Food (Please specify):
Date and type of last reaction:
Other health concerns:
If symptoms of this medical condition or allergy are exhibited during school, I would like the staff to take the following action(s):
_____________________________________________________________________
My child takes the following medications: (Please annotate if these medications are take at home or school):
Verification of any allergies or medical conditions is required from your child's physician.Students with severe allergies or those that take medication at school must have a
Form SH36 on file.
Consent for Emergency Medical or Surgical Care
In the event that child becomes ill or is injured at school, and I cannot be contacted, school authorities have my permission to contact and
release my child to the custody of the emergency contacts listed above.
In the event that I cannot be contacted, I hereby give my permission and authorize Navy Hale Keiki School to obtain appropriate medical
or hospital personnel to provide emergency medical or surgical care for my child. I will assume the cost of any necessary medical or
surgical care.
Unless sooner revoked or terminated by me, this Consent for Emergency Medical or Surgical Care shall become null and void from and
after July 31, 2016.
I understand my obligation to submit in writing to the school office any changes in my contact information.
Signature of Parent/Legal Guardian
Date
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NAVY HALE KEIKI SCHOOL
PHOTOGRAPHIC AND PUBLICITY PERMISSION FORM
PRINTED PUBLICATIONS
Navy Hale Keiki School on occasion may wish to include captured imagery in printed publications. Images may be captured during
events organized and hosted by the school using film photography, digital photography, video, or other medium and maybe used in
the following publications. Examples of printed publications:
•
Navy Hale Keiki School bulletin
•
Navy Hale Keiki School leaflets and posters
•
Navy Hale Keiki School course brochures
•
Other Navy Hale Keiki School publicity material
•
Articles in local media, e.g. Star Bulletin, Navy News, Honolulu Magazine
•
Navy Hale Keiki School yearbook
Please note that any printed publications and publicity material may be replicated on the school website.
ONLINE AND ELECTRONIC PUBLICATIONS
Navy Hale Keiki School on occasion may wish to include captured imagery online and in electronic publications and on the school
website. Images may be captured during events organized and hosted by the school using film photography, digital photography,
video, or other medium and maybe used in the following publications. Examples of electronic publications:
•
Navy Hale Keiki School PowerPoint presentations
•
Navy Hale Keiki School prospectus
•
Navy Hale Keiki School course brochures
•
Navy Hale Keiki School website
Any images used for generic/illustrative purposes on the website may be replaced with more recent images/film regularly. Images of
students associated with particular news stories or events may remain on the school website in perpetuity, but will be archived as
new stories and events are added. Please note that websites can be viewed throughout the world and not just in the United States
where U.S. law applies.
CONDITIONS OF USE
1. We will not include personal email or postal addresses, or telephone or fax numbers on video, on our website or in any school
documentation.
2. We may use group or class photographs or footage with very general labels such as "science lesson" or "students at play."
PLEASE COMPLETE AND RETURN THIS FORM TO THE SCHOOL
This form gives consent for the school to use pictures of the person named below for media, general publicity, including (but not
limited to) the school website, leaflets, posters, display materials, prospectus, and reports.
Print Name: ________________________ Signed: ____________________________________________
Relationship to Child: ______________________________________
Date: ___________________
Print Child's Full Name: __________________________________________________________________
Please Select One of the Following:
YES, I give permission for my child to be included in any publicity/publication material, in school and externally, with local
media such as those mentioned in this form. I also give permission for any digital photography/video to be used for this use or for
press releases.
NO, I do not wish my child to be included in any publications and/or publicity materials either in school or externally with local
media such as those mentioned in this form. I also do not wish any digital photography/video to be used or for this use or press
release.
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NAVY HALE KEIKI SCHOOL
SUMMER 2015 TUITION SCHEDULE
MONTHLY BILLING STATEMENTS ARE NOT PROVIDED
Please refer to this sheet and your copy of the Tuition Agreement for any questions regarding
billing and procedures.
Registration Fee: $50.00
SESSION 1: June 1-June 26
GRADE
Preschool-5th
Grade
EARLY BIRD CARE
BEFORE SCHOOL
CARE
AFTER SCHOOL
CARE
TUITION
6:00 a.m. - 7:30 a.m.
7:00 a.m. - 7:30 a.m.
until 5:30 p.m.
DAILY AFTER
SCHOOL CARE
$590.00
$169.00
$65.00
$304.00
$16.75
(8:00 a.m. - 12:00 p.m.)
SESSION 2: June 29-July 17
GRADE
Preschool-5th
Grade
EARLY BIRD CARE
BEFORE SCHOOL
CARE
AFTER SCHOOL
CARE
TUITION
6:00 a.m. - 7:30 a.m.
7:00 a.m. - 7:30 a.m.
until 5:30 p.m.
DAILY AFTER
SCHOOL CARE
$450.00
$129.00
$49.00
$214.00
$16.75
(8:00 a.m. - 12:00 p.m.)
TUITION WILL BE ASSESSED FOR CANCELLATIONS
MADE AFTER MAY 15, 2015
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NAVY HALE KEIKI SCHOOL
TUITION AGREEMENT – Summer Enrichment 2015
Signatures and initials from both guardians are required (if applicable). At least one guardian must complete his/her signature
and initials at registration and witnessed by the Business Manager.
For Military Families Only: If you are not the active duty military member and you are signing in their place, a copy of your Power
of Attorney will be required.
1. _____ Registration Fees are due at the time of registration and are not refundable or transferable.
2. _____ Navy Hale Keiki School does not generate billing statements. Tuition fees as well as full time before or after school care fees for
Summer Session I are due by May 15, 2015. Tuition fees as well as full time before or after school care fees for Summer Session II are due by
June 15, 2015. Accounts not paid in full by these dates, may result in disenrollment from the program.
3. _____ For those without a FACTS account, payments must be in the form of a personal check, cashier’s check, or money order. For all others,
payments will be deducted from your FACTS account. NHKS is unable to accept any cash payment over $20.00.
NHKS does not accept any form of credit card payments. Checks returned to the school for any reason will incur a $30.00 charge. The returned
check will not be redeposited. Payment will need to be made by money order or cashier’s check. A second returned check will require that all
future payments be made by money order or cashier’s check.
4. _____ The school must be notified of disenrollment no later than May 15, 2015 for Summer Session I and June 15, 2015 for Summer Session II.
A copy of official military orders or Bill of Lading from the moving company along with the school’s disenrollment notice must be submitted to
receive a tuition refund.
5. _____ Tuition refunds are not given for students involuntarily withdrawn from school due to uncorrected behavior.
6. _____ Tuition refunds are not given for students voluntarily withdrawn from school for reasons including, but not limited to, moving homes on
island, receiving a geographical exemption for another school, vacations, or deployments.
7. _____ Children should be picked up promptly at dismissal times. A late pick up fee of $2.00 for every 5 minutes or fraction thereof will be
th
assessed. After the 5 late pick-up, parents will be charged $10.00 for every 5 minutes or fraction thereof. (Refer to the Parent Handbook for
additional information on late pick-up fees.)
8. _____ Children in After School Care who are not picked up by 5:30 p.m. will be charged $10.00 for every 10 minutes or fraction thereof after 5:30
p.m. (Refer to the Parent Handbook for additional information on After School Care dismissal policies.)
I have read, understand, and agree to the above. In the event that my account is 60 days or more in arrears, and following unsuccessful attempts
by Navy Hale Keiki School to communicate with and/or collect from me, I consent to Navy Hale Keiki School communicating with my Commanding
Officer, Officer-In-Charge, or other employer, however denoted, concerning my indebtedness/delinquent account. If legal action is necessitated, I
agree to pay any additional legal or collection costs. If my account is sent to collections, I agree that my account will be assessed an additional 50%
of the outstanding balance. All above statements, #1-8, become applicable at the time of signing.
Student’s Legal Name (please print) _______________________________________________
____________________________________________
Parent/Legal Guardian Name (Print)
____________________________________________
Parent/Legal Guardian Name (Print)
____________________________________________
Parent/Legal Guardian Social Security Number
____________________________________________
Parent/Legal Guardian Social Security Number
____________________________________________
Parent/Legal Guardian Signature
____________________________________________
Parent/Legal Guardian Signature
Date:
Date:
__________________
_______________________________________________
Business Manager’s Signature
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