SS 2013

SUMMER PROGRAM 2013 REGISTRATION FOR GRADES 4-8

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: Email: School presently attending 2012 – 2013: Grade School attending in 2013 – 2014: Entering Grade *Base tuition totals on your first choice. If the first choice course is full, the second choice class will be factored in the tuition total. Thank you!

TIME COURSE (select a 1st & 2nd choice course for each period)

Do not leave any blanks

ENTERING GRADE

(School Year 2013-2014)

TUITION $165.00 per

Regular Course *$270 per

Intensive Course

+ LAB FEE

(if applicable)

TUITION TOTAL per Course

Pd. 1 8:00-8:50 1) = $ 2) Pd. 2 8:55-9:45 1) = $ 2) Break 9:45 - 10:00 Pd. 3 10:00-10:50 1) = $ 2) Pd. 4 10:55-11:45 1) = $

2) Sub-Total $

AFTER SCHOOL PROGRAM 11:45 AM - 5:00 PM

Entering Grades 4-8 (Please check one below)

TUITION Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 + $ 660.00

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 96816 Registration forms without the accompanying full payment will not be processed. ________________________________________________________________ ______________ Signature of Parent or Guardian Date ______________________________________________________________ Print Name

SS

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3

SUM

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dem

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2 e

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**

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is $

165

+ La

b F

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8:

00 –

8:5

0 8:

55 –

9:4

5 10

:00

– 10

:50

10:5

5 –

11:4

5 M

ath

7 M

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8 M

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R

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R

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R

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M

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A

rt 1

(4-5

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0 C

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(4-5

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e $4

0 C

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(6-8

) La

b Fe

e $4

0 A

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(6-8

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0

Cho

w F

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(4-5

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0 C

how

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2 (6

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Lab

Fee

$40

Jew

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(6-8

) La

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wel

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g (6

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Lab

Fee

$50

Key

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(4-5

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(6-8

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(4-5

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Phys

ical

Fitn

ess &

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2 (6

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is &

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(6-8

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inni

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abric

Pro

ject

s (4-

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Lab

Fee

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and

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lt (6

-8)

Lab

Fee

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SS 2013

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: E-Mail 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 2013. 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 Date ___________________________________________________________ Print Name

SS 2013

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, . I understand that Sacred Print Name of Child 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___.

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... ...................................................... 5 weeks at $109.25 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 - $109.25 ■ 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, 2013. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

SACRED HEARTS ACADEMY SODEXO FOOD SERVICES (808) 734-5058 ext. 329

Sodexo Summer School Payment ~ $109.25

*Please make checks payable to Sodexo

Student Name:

Grade

Homeroom No. & Teacher

Parent/Guardian: Home Phone: Cell Phone: Work Phone: E-mail Address: Food Allergy:

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-$5.00

7” 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

JUNE 2013

Mon Tue Wed Thu Fri

10 11 12 13 14 Open House

Hamburger Steak Hapa Rice Orange Wedges Steamed Broccoli

BBQ Pork Sandwich Tortilla Chips Fresh Cut Pineapple Green Beans

Cheese Pizza Pretzels Watermelon Toss Greens

Fish Filet w/ Tartar Sauce Hapa Rice Grapes Carrot Sticks

17 18 19 20 21 Shoyu Chicken Hapa Rice Mandarin Orange Mixed Vegetables

Spaghetti w/ Meat Sauce Whole Wheat Bread Cantaloupe Celery Sticks

Turkey & Cheese Sandwich on Whole Wheat Bread Tortilla Chips Banana Toss Greens

Corn Dog Tortilla Chips Chilled Peaches Corn

Teri Burger on Whole Wheat Bun Pretzels Orange Wedges Sliced Cucumber

24 25 26 27 28 Italian Meatball Sub Tortilla Chips Chilled Pears Carrot Sticks

Grilled Cheese on Whole Wheat Pretzels Honeydew Toss Greens

Kalua Pig & Cabbage Hapa Rice Fresh Cut Pineapple Green Beans

Beef Ravioli Whole Wheat Garlic Bread Apple Slices Italian Blend Veggies

Baked Chicken Nuggets Baked Tater Tots Watermelon Celery Sticks

JULY 2012

Mon Tue Wed Thu Fri

1 2 3 4 5 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

8 9 10 11 12 BBQ Meatballs Hapa Rice Grapes Mixed Vegetables

Turkey Ala King Egg Noodles Oranges Wedges Steamed Broccoli

Spinach Soba Salad w/ Teriyaki Chicken Banana Shredded Lettuce

Shepherd’s Pie Whole Wheat French Bread Chilled Peaches Green Beans

Tuna Melt Tortilla Chips Apple Slices Carrot Slices

SUMMER SCHOOL 2013 SUPPLY LIST GRADES FOUR TO EIGHT

■ GRADES FOUR TO EIGHT (Child needs a nutritious snack and drink each day, unless otherwise informed)

1 - Folder (Two-pocket style)

1 - Package of College-Ruled Folder Paper

2 - Black Pens

6 - #2 Pencils

1 - Eraser

NOTE: EACH TEACHER WILL PROVIDE THEIR OWN SUPPLY LIST REQUIRED FOR THE SPECIFIC CLASS THEY TEACH. THE SUPPLIES LISTED ABOVE ARE BASIC SUPPLIES TO HAVE THE FIRST DAY OF SUMMER SCHOOL.