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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
201
3
SUM
ME
R S
CH
OO
L 2
013
CO
UR
SE S
EL
EC
TIO
N C
HA
RT
- G
RA
DE
S 4
– 8
*P
leas
e se
lect
one
cou
rse
for e
ach
peri
od.
Tuiti
on is
$66
0 =
4 co
urse
s; 2
aca
dem
ic +
2 e
lect
ives
**
Eac
h co
urse
is $
165
+ La
b F
ee (i
f app
licab
le)
8:
00 –
8:5
0 8:
55 –
9:4
5 10
:00
– 10
:50
10:5
5 –
11:4
5 M
ath
7 M
ath
8 M
ath
5 M
ath
4 R
eadi
ng 8
R
eadi
ng 7
R
eadi
ng 4
R
eadi
ng 5
M
ath
6 R
eadi
ng 6
A
rt 1
(4-5
) La
b Fe
e $3
0 C
eram
ics 1
(4-5
) La
b Fe
e $4
0 C
eram
ics 2
(6-8
) La
b Fe
e $4
0 A
rt 2
(6-8
) La
b Fe
e $3
0
Cho
w F
un 1
(4-5
) La
b Fe
e $4
0 C
how
Fun
2 (6
-8)
Lab
Fee
$40
Jew
elry
Mak
ing
(6-8
) La
b Fe
e $5
0 Je
wel
ry M
akin
g (6
-8)
Lab
Fee
$50
Key
boar
ding
, Mic
roso
ft O
ffic
e (4
-5)
iPad
for S
ucce
ss 1
(4-5
) iP
ad fo
r Suc
cess
2 (6
-8)
Com
ic L
ife/D
igita
l Pub
lishi
ng (6
-8)
Let’s
Exp
erim
ent 1
(4-5
) La
b Fe
e $3
0 LE
GO
-My
Rob
ot 1
(4-5
) La
b Fe
e $4
0 LE
GO
-My
Rob
ot 2
(6-8
) La
b Fe
e $4
0 H
ow S
tuff
Wor
ks 2
(6-8
) La
b Fe
e $3
0 M
usic
al T
heat
re 1
(4-5
)
Cre
ativ
e D
ance
(6-8
) M
usic
al T
heat
re 2
(6-8
) St
udy
Skill
s (4-
5)
Ph
ysic
al F
itnes
s & F
un 1
(4-5
)
Phys
ical
Fitn
ess &
Fun
2 (6
-8)
Tenn
is &
Bow
ling
(6-8
)
Beg
inni
ng F
abric
Pro
ject
s (4-
5)
Lab
Fee
$40
Let’s
Sew
and
Qui
lt (6
-8)
Lab
Fee
$40
Zu
mba
tom
ic 1
(4-5
)
Zum
bato
mic
2 (6
-8)
*Int
ensi
ve C
ours
e is
$27
0 ea
ch
Inte
nsiv
e M
ath,
Rea
ding
& W
ritin
g –
Lim
ited
to 6
stud
ents
per
cla
ss
8:00
– 8
:50
8:55
– 9
:45
10:0
0 –
10:5
0 10
:55
– 11
:45
Inte
nsiv
e M
ath
7 In
tens
ive
Mat
h 8
Inte
nsiv
e M
ath
5 In
tens
ive
Mat
h 4
Inte
nsiv
e R
eadi
ng &
Writ
ing
8 In
tens
ive
Rea
ding
& W
ritin
g 7
Inte
nsiv
e R
eadi
ng &
Writ
ing
4 In
tens
ive
Rea
ding
& W
ritin
g 5
Inte
nsiv
e M
ath
6 In
tens
ive
Rea
ding
& W
ritin
g 6
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.
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