ʻŌpio Enrollment Form

Yes, I'm interested in the ʻŌpio Program!

* Indicates required field

Student Name: *

Student Email: *

Student Phone Number: *

Gender: *

Female Male

School: *

Waimānalo Elementary and Intermediate School Kailua Intermediate School Kailua High School Kaiser High School Kalaheo High School Kamehameha Schools

other school: *

Grade: *

Returning Student to Hui Mālama O Ke Kai? *

Yes No

Parent/Legal Guardian Name: *

Address: *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number: Home *

Cell: *

Work: *

Parent/Guardian Email: *

Do you have a Facebook account? *

Yes No

How did you hear about our ʻŌpio Program? *

Friend/Family School Counselor Flyer Internet

If Other please specify: *

Submit

ALOHA - PONO - PAʻAHANA