No'eau Learning Box and Papa Ku'i 'Ai Order Form
This is a resource loan program. We will loan you a box of no'eau resources and activities, deliver it to you and then pick it up from you in two weeks. If you reserve a papa ku'i 'ai, you must be home during the drop off and pick up times. We will not leave these items at your doorstep. Drop off and pick up is after 4pm. You are welcome to drop off items at our facility in Kalaeloa. After you fill out this order request, you will receive an email with delivery 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
*
-
Area Code
Phone Number
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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Which household members are Native Hawaiian? Please list their first names.
*
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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Delivery Fee
$
10.00
Quantity
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Total
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0.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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the form.
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