Part-time Admissions

We are very excited to have your child join Pono!

There are two parts to our Admissions Application: Enrollment & Health Forms and Health Related Information and Emergency Contacts.

Please click on the links below to download the Enrollment Form (needs your signature) and the Health Form (needs your child’s pediatrician’s signature).

Download Enrollment Form To Sign

Download Health Form to submit to your child's pediatrician

Print, fill in, scan, and upload the Enrollment and Health Forms using the button below.

Upload Enrollment and Health Forms

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Health Related Information and Emergency Contacts

Child's Name

First Name

Last Name

Child's Date of Birth

MM

DD

YYYY

Does your child have any medical issues of which we should be aware?

Does your child have any food allergies?

Does your child follow any special diets or have any food restrictions?

Emergency Contact 1

Parent or Guardian

First Name

Last Name

Mobile Phone

(###)

###

####

Email

Other Phone

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact 2

Leave blank if only one parent or guardian.

Parent or Guardian

First Name

Last Name

Mobile Phone

(###)

###

####

Email

Other Phone

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact 3

If Pono cannot get in touch with either parent/guardian, please name a friend or relative who may be called upon if your child becomes sick, or in case of any other emergency.

Name

First Name

Last Name

Relation

Mobile Phone

(###)

###

####

Other Phone

(###)

###

####

Emergency Contact 4

If Pono cannot get in touch with either parent/guardian, please provide the contact info of your child’s doctor whom we may contact if your child becomes sick, or in case of any other emergency.

Child's Doctor's Name

First Name

Last Name

Doctor's Phone

(###)

###

####

If none of the above can be reached by phone, what do you wish Pono to do in case of an emergency?