No'eau Learning Box Order Form
This is a resource loan program. We will loan you a box of no'eau resources and activities and you return it at the end of 2 weeks. Pick Up and Drop Off of boxes are at our learning center in Kalaeloa at 91-1080 Saratoga Avenue. After you fill out this order request, you will receive an email with pick up details. Please don't hesitate to contact us if you have any questions: (808) 722-3036.
Email
*
example@example.com
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
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Area Code
Phone Number
Enter in the date you would like to pick up the box.
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Month
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Day
Year
Date
All information must be completed. This information is required by our funders. Incomplete information will result in your order being canceled. List household members who will be using the resources in the box? There must be at least 4 family members who will use the box.
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I'd like to reserve a No'eau Learning Box
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I'd like to reserve a papa ku'i 'ai and pohaku
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Does your family speak Hawaiian at home? If you indicate YES, we will include Hawaiian language resources in your box.
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Yes
No
I agree to take care of all items loaned to me and return all materials on the pick up date.
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Yes. I will take care of items.
No. I don't think I could do it.
I agree to complete a survey at the end of my loan period. (You must be willing to complete the survey to be considered for this program)
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Yes. I will complete a survey at the end of my loan period.
No. I don't feel comfortable completing surveys.
Delivery Fee
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Payment Methods
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First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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