Parent/Guardian Name:*

First NameLast Name

Email*

example@example.com

Date

School Name*

Program:*

Program*

School Location (old)*

Name*

First NameLast Name

Birthday

Date

Age*

Gender*

FemaleMale

Grade*

Class Name/Number

Siblings (same school location)

*Please also provide age and grade level here

Health issues/concerns:*

*Please be as detailed as possible

Allergies

*Please be as detailed as possible

Other concerns or focal points:

IMPORTANT: This list is used for pick ups and/or emergency situations if primary parent/guardian is not available. If an adult is not listed here, they will not be authorized to exit with student. The responsible adult must be able to show identification. Our students safety is our number one priority and this will be strictly enforced. It is the primary parent/guardians responsibility that this list is updated.

Guardian:*

First NameLast Name

Phone Number*

Area CodePhone Number

Relation to Student:*

Guardian 2:*

First NameLast Name

Phone Number: (Guardian 2)*

Area CodePhone Number

Relation to Student: (Guardian 2)*

Guardian 3:*

First NameLast Name

Phone Number: (Guardian 3)*

Area CodePhone Number

Relation to Student: (Guardian 3)*

Guardian 4: (Optional)

First NameLast Name

Phone Number: (Guardian 4)

Area CodePhone Number

Relation to Student: (Guardian 4)

Guardian 5: (Optional)

First NameLast Name

Phone Number: (Guardian 5)

Area CodePhone Number

Relation to Student: (Guardian 5)

Which is applicable?*

My child/children will be picked up at their classrooms by the Menehune staff then a parent or legal guardian will pick them up after program endsMy child/children will be picked up at their classrooms by the Menehune staff and will be dropped off to A+ or a different after school program when program is finishedMy child/children will be dropped off to the program and picked up by parent or legal guardian listed aboveOther

By signing here, I affirm my role as the primary caregiver and confirm that I am legally responsible for the registered child/children. I can provide documentation to support this claim if required. Additionally, I authorize the listed adults above to act as guardians for my child/children when the program concludes or in my absence.

Signature*

This Participation Agreement ("Agreement") is made and entered into as of the registration date below by and I acknowledge and accept all terms below:

Responsibilities and Expectations:

Attendance:

1. Ensure the student attends program sessions regularly and on time.

2. Notify Menehune Hammahs in advance if the student will be absent.

3. Understand that excessive absences may result in the student being removed from the program.

4. Be aware that no make-up classes will be provided for absences, except in cases of unforeseen occurrences such as bad weather or other emergencies as determined by Menehune Hammahs.

Support and Engagement:

1. Support and encourage the student’s participation and engagement in the program.

2. Communicate any concerns or issues promptly to Menehune Hammahs staff.

Payment Responsibilities:

1. Pay all program fees on time as outlined in the payment schedule. It is my responsibility to keep payment information current and notify Menehune Hammahs.

2. Failure to do so will result in additional fees after the set pay date.

3. Understand that all payments are automatic on the 1st of each month

4. A yearly registration fee ($25) will be applied at the time of registration. This helps with the upkeep of equipment and other program needs.

5. Understand that non-payment may result in the student being excluded from the program.

Code of Conduct:

1. Ensure the student behaves respectfully and responsibly at all times.

2. Understand that bullying, harassment, or any form of misconduct will not be tolerated and may result in disciplinary action, including dismissal from the program.

Safety and Health:

1. Provide accurate health information and emergency contact details.

2. Ensure the student follows all safety guidelines and procedures during program activities.

3. Understand that in case of illness or injury, Menehune Hammahs staff will take appropriate action and contact parents/guardians as necessary.

4. I fully understand that if my child is not well, I will not bring them to the program for the health and safety of others. Doing so repeatedly may result in early termination of the program.

Media Release:

1. Consent to the use of photographs, videos, and other media featuring the student for promotional and educational purposes by Menehune Hammahs.

2. Opt out of this consent by providing a written notice to Menehune Hammahs if desired.

Liability Waiver:

Release and hold harmless Menehune Hammahs, its staff, volunteers, and affiliates from any and all liability, claims, or demands arising from the student's participation in the program.

Confidentiality:

1. Understand that Menehune Hammahs will maintain the confidentiality of all student information in accordance with applicable laws and regulations.

2. Respect the confidentiality of other participants.

Pick-Up Times:

1. Ensure timely pick-up of the student at the designated end time of the program.

2. I commit to respecting my child and other children by allowing the program to proceed without interruption and by allowing the instructor to direct the class. If there is a need for early dismissal, I will notify Menehune Hammahs as soon as possible.

3. I understand that, in accordance with the safety policy, an ID may be required when signing my child out at pickup, unless otherwise stated in my preference above.

4. If class times are during school hours, I understand that my child will be directed back to their assigned classroom and/or designated area.

5. I understand that a late pick up fee may be applied.

Agreement Term:

This Agreement is effective from the registration date below until the end of the program session (Summer) unless terminated earlier in accordance with the terms of this Agreement.

Termination:

Either party may terminate this Agreement with [30] days written notice to the other party.
Menehune Hammahs reserves the right to terminate a student’s participation for failure to comply with the program’s policies and expectations

Program Overview:

I acknowledge and understand that this program provides hands-on, practical learning experiences in physical health.

I acknowledge that I have read and outlined policies, responsibilities, and expectations for my participating children.

If there is a concern or further questions, it is my responsibility to reach out to Menehune Hammahs to help me do so.

By signing below, the party acknowledge that they have read, understood, and agree to the terms and conditions outlined in this Agreement.

Signature*