SUMMER PROGRAM 2013 REGISTRATION FOR GRADES JK-3 June 11 - July 12, MORNING PROGRAM 8:00 AM to 11:45 AM Tuition Cost $660

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1 SUMMER PROGRAM 2013 REGISTRATION FOR GRADES JK-3 June 11 - July 12, 2013 Please complete and print all information below. Do not leave any blanks. Student s Name: Female Male Birthdate: Age: Student's Address: City State Zip Home Phone: School presently attending : School attending in : Grade Entering Grade Please note: Junior Kindergarten enrollees have the option to enroll in a half day or full day program. Grades SK-3 enrollees have the option to enroll in a morning program only or both morning and afternoon programs. Please indicate by circling the grade level your child will be enrolling in for school year below. ENTERING GRADE (School Year ) Please check one below MORNING PROGRAM 8:00 AM to 11:45 AM Tuition Cost $660 AFTERNOON PROGRAM 11:45 AM to 5:00 PM Tuition Cost $660 TUITION TOTAL Junior Kindergarten Half Day $ = $ Junior Kindergarten Full Day $ $ = $ Senior Kindergarten $ $ = $ Grade 1 $ $ = $ Grade 2 $ $ = $ Grade 3 $ $ = $ Total Tuition Enclosed $ Mail a check payable to Sacred Hearts Academy with each registration form to: Sacred Hearts Academy Attn: Terry Ching, Lower School Office 3253 Waialae Avenue Honolulu, HI Registration forms without the accompanying full payment will not be processed. Signature of Parent or Guardian Date Print Name SS 2013

2 SUMMER PROGRAM 2013 EMERGENCY FORM FOR GRADES JK-8 Please complete and print all information below. Do not leave any blanks. Student s Name: Entering Grade: PARENT INFORMATION Father Mother Name: Place of Work: Occupation: Home/Work Phone: H: W: H: W: Cellular or Pager: C: P: C: P: Address: I agree to abide by the policies set forth in the Summer School handbook. EMERGENCY INFORMATION In case of an emergency, if you are unable to contact me, you may take my child to emergency care. I understand that he/she will be accompanied by a school official. In case of an emergency and you cannot reach us, please contact the following: 1. Name: Relationship: Home Phone: Cellular: Work: Pager: 2. Name: Relationship: Home Phone: Cellular: Work: Pager: Medical information the school should know about my child (list medical conditions): FIELD TRIP INFORMATION My child: has my permission to attend and participate in all the activities and field trips sponsored by Sacred Hearts Academy SUMMER SCHOOL I understand that reasonable caution will be taken to insure the safety of my child; however, I shall not hold the school, the teachers and the chaperones liable in case of accidents. Signature of Parent or Guardian Print Name Date SS 2013

3 SUMMER PROGRAM 2013 ADVERTISING/PHOTOGRAPHIC RELEASE FORM FOR GRADES JK-8 Please complete this form and return it to the grades JK-8 summer school office no later than Tuesday, June 11, 2013, first day of Summer School. Do not leave any blanks. Thank you! I,, give Sacred Hearts Academy permission to take Print Name of Parent/Legal Guardian photographs of my child, Print Name of Child. I understand that Sacred Hearts Academy produces various brochures, flyers and announcements for advertising purposes as well as for other school events. I understand that my child s photograph and/or voice may be used in these publications. I hereby authorize Sacred Hearts Academy to use my child s photograph/image/voice for advertising purposes as directed by their discretion. Media images may include audio and other Visual recording medium such as video. Child s First Name Child s Last Name Entering Grade Street Address City State Zip Code Signature of Parent/Legal Guardian Date Print Name of Parent/Legal Guardian If you do not wish to give this release for your child, please check here. SS 2013

4 SACRED HEARTS SUMMER 2013 MEAL PLAN INFORMATION: HOURS OF SERVICE PRICES Breakfast 7:00 a.m. 8:00 a.m... Items and prices vary Snack 9:45 a.m.-10:00 a.m.... Items and prices vary Hot Lunch 11:45 a.m. 1:00 p.m weeks at $ Snack Bar 11:45 a.m. 1:00 p.m.... Items and prices vary PRICES: Meal Plan (hot lunch only, advance purchase) Five-week summer meals - $ All hot lunches meets the USDA nutrition guidelines, an entrée, starch, fruits, vegetables, and milk. Meal Plans for the summer, will not be replaced or refunded, nor accepted during the regular school year. NOTE: Meal Plans are only for hot lunch, snack bar can be purchased with cash. Hot lunch will not be available for purchase, outside of the meal plan. To purchase 2013 Meal Plan, please complete attached form below and turn into the Summer School Office (the Lower School Office) by June 5, SACRED HEARTS ACADEMY SODEXO FOOD SERVICES (808) ext. 329 Sodexo Summer School Payment ~ $ *Please make checks payable to Sodexo Student Name: Parent/Guardian: Grade Homeroom No. & Teacher Home Phone: Cell Phone: Work Phone: Address: Food Allergy:

5 BREAKFAST MENU Mini Breakfast Bento (Rice, Egg, & 1 Meat)... $3.50 Breakfast Sandwich (English Muffin, Egg, Cheese, & Meat)... $ 2.75 Acai Bowl... $4.00 Cold Cereal & Milk... $2.00 Parfait... $3.00 Bagels & Cream Cheese... $2.75 Assorted Muffins & Donuts... $1.25-$1.50 Whole Fruit (Apple & Bananas)... $1.00 Fruit Salad... $3.00 Milk, Orange Juice, POG... $1.00 SNACK BAR MENU Chicken Cesar Salad... $4.00 Cesar Salad... $3.50 Toss Salad... $3.00 Deli Sandwich... $3.00 Egg or Tuna Sandwich... $2.50 Burgers... $2.50 Fish Burgers... $3.25 Special Mini Bento... $4.25-$ Pizza... $3.50-$4.00 Manapua... $1.75 Saimin... $2.00 Spam Musubi... $1.75 Hot Pocket... $2.75 Chips... $1.00 Chex Mix... $2.50 Canned Juice... $1.00 Assorted Gelato... $2.50 Assorted Sorbet... $2.50

6 JUNE 2013 Mon Tue Wed Thu Fri Open House Hamburger Steak BBQ Pork Sandwich Cheese Pizza Fish Filet w/ Tartar Tortilla Chips Pretzels Sauce Orange Wedges Fresh Cut Pineapple Watermelon Steamed Broccoli Green Beans Toss Greens Grapes Carrot Sticks Shoyu Chicken Mandarin Orange Mixed Vegetables Spaghetti w/ Meat Turkey & Cheese Corn Dog Teri Burger on Whole Sauce Sandwich on Whole Tortilla Chips Wheat Bun Whole Wheat Bread Wheat Bread Chilled Peaches Pretzels Cantaloupe Tortilla Chips Corn Orange Wedges Celery Sticks Banana Sliced Cucumber Toss Greens Italian Meatball Sub Tortilla Chips Chilled Pears Carrot Sticks Grilled Cheese on Kalua Pig & Cabbage Beef Ravioli Baked Chicken Whole Wheat Whole Wheat Garlic Nuggets Pretzels Fresh Cut Pineapple Bread Baked Tater Tots Honeydew Green Beans Apple Slices Watermelon Toss Greens Italian Blend Veggies Celery Sticks JULY 2012 Mon Tue Wed Thu Fri Beef Soft Taco Spanish Rice Mandarin Oranges Shredded Lettuce and Diced Tomato Hot Dog Potato Chips Watermelon Carrot Sticks Chicken Chow Mein Edamame Fruit Cocktail Independence Day Fish Burger on Whole Wheat Bun Pretzels Cantaloupe Celery Sticks BBQ Meatballs Grapes Mixed Vegetables Turkey Ala King Spinach Soba Salad Shepherd s Pie Tuna Melt Egg Noodles w/ Teriyaki Chicken Whole Wheat Tortilla Chips Oranges Wedges Banana French Bread Apple Slices Steamed Broccoli Shredded Lettuce Chilled Peaches Carrot Slices Green Beans

7 SUMMER SCHOOL 2013 SUPPLY LIST GRADES KINDERGARTEN TO THREE JUNIOR KINDERGARTEN AND SENIOR KINDERGARTEN (Child needs a nutritious snack and drink each day, unless otherwise informed) 1 - Set of Extra Change of Clothes - t-shirt, shorts, underwear and socks (uniforms not required during the summer) 1 - Jacket for Air-Conditioned Classroom 1 - Art Apron 1 - Sleeping Bag or Crib Sheet (Required for full day summer school program only) NOTE: PLEASE LABEL ALL ITEMS WITH CHILD S NAME GRADES ONE TO THREE (Child needs a nutritious snack and drink each day, unless otherwise informed) 6 - Pencils with Erasers 1 - Eraser 1 - Box Crayola Markers (8 count) 1 - Box Crayola Crayons (16 count) 1 - Pair Scissors 1-12-Inch Ruler 1 - Bottle Elmer s Glue 2 - Large Glue Sticks 1 - School Supply Box 1 - Backpack (no wheels) 1 - Pair of ear phones (Ear buds; or head phones whichever you prefer. Please label with name and bring it in a labeled Ziploc bag.) NOTE: PLEASE LABEL ALL ITEMS WITH CHILD S NAME