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HOUSING REGISTRATION
Hawaii Pacific University: Aloha Tower Waterfront Lofts
Parent/Guardian Information
All information will be sent to this person.
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian E-mail
*
Confirmation Email
This address will be subscribed to our mailing list.
Parent/Guardian Relationship to Student
*
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Guardian
Parent/Guardian Cell Phone
*
HYS uses Remind to communicate.
Available to volunteer as a chaperone?
*
Yes
No
Student Information
Student Name
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date Picker Icon
Gender Pronouns
*
he/him
she/her
they/them
other
Preferred Pronouns (if other)
Student E-mail
Confirmation Email
Student Cell Phone
HYS uses Remind to communicate with students.
Please select
*
Jazz Intensive
MS All-State Band
Strings Program
Ukulele Workshop
Wind Ensemble
Any allergies and dietary restrictions:
Examples: vegetarian, specific food allergies
Please list all prescribed medications
Product Selection
You may select more than one program. Remember to indicate your instrument
Please select ALL the programs you would like to participate in and indicate your instrument for each program.
*
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PMI2023 Dorming Package
$
1,675.00
includes housing (with 1-3 roommates), meals, and transportation
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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