Registration

summer program Registration

Trailblazers - A Hiking Immersion
June 1–12 | 9:00am–12:00pm | $450

Girls Full STEAM Ahead: Robotics & Design Studio
June 3–18 | 9:00am–2:30pm | $975

Parent & Student Information

Choose Summer Program*

Student Full Name *

Student Email*

Student Grade in 2026-2027 School Year*

School Currently Attending *

Home Address*

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Address 1:

City:

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Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent Phone Number* - -

Parent Email*

Second Parent/Guardian First Name

Second Parent/Guardian Last Name

Second Parent Phone Number - -

Second Parent Email

RELEASE FORMS

With whom will your child go home?*

Please list anyone who might be picking-up your child, including you, the parents and/or guardians. For your child's protections, we will not release your child to anyone other than the persons listed below.

Emergency Medical Contact*

List any additional emergency contact(s) and their contact information to be used if your child is seriously ill or injured.

Allergies*

List any allergies that we should be aware of.

Excursion Release*Yes, I consent.

Hawai‘i School for Girls at La Pietra (HSG) will take all precautionary measures to ensure your child's safety on planned excursions. By checking this box, I the parent/guardian, give permission to HSG to take my child on all excursions by bus or within walking distance. I release HSG from responsibility in case of an accident. I further understand that information regarding the excursion will be given prior to the event.

Media Release*Yes, I consent.No, I do not consent.

We, parents/guardians, consent to photography, audio recording, video recording and it's/their release, publication, exhibition, or reproduction to be used for news, web casts, promotional purposes, telecasts, advertising, inclusion on websites, social media, or any other purpose by Hawai‘i School for Girls at La Pietra (HSG) and its affiliates and representatives. You release HSG, its officers and employees, and each and all persons involved from any liability connected with the taking, recording, digitizing, or publication and use of photographs, computer images, video and/or sound recordings.

TechZone Waiver of Liability Form

This Consent and Release/Waiver of Liability form must be completed, signed, and submitted by a parent/legal guardian before a student may participate in Hawaii School for Girls at La Pietra in partnership with Coconut Wireless Network LLCs’ during and after school TechZone Program (the “Program”). Program activities include, but are not limited to, Esports, robotics, 3D-printing, virtual reality (VR) and podcasting.

Part I: Consent and Permission to Participate*Yes, I consent.

I, the undersigned parent or legal guardian, do hereby consent to my child’s participation in the Program. I have read and understand the information concerning the Program.

Part II: Emergency Authorization *Yes, I consent.

In the event the School is unable to immediately reach the emergency contact listed, or in the case of an emergency, I give the School, its employees, volunteers or TechZone coaches permission to take action as it deems necessary for the safety and welfare of my child, including, but not limited to, seeking and securing medical treatment for my child. I understand and agree that I will be financially responsible for any medical treatment or procedure resulting from my child’s participating in the Program.

Part III: Assumption of Risk/Liability *Yes, I consent.

I understand that my child’s participation in the Program entails known and unknown risks and that participation in the Program could result in physical or emotional injury, illness, permanent disability, death, or damage to my child or my child’s property. I voluntarily assume all risks and hazards incidental to my child’s participation in the Program. I, on my own behalf, on behalf of my child, and on behalf of anyone who may assert claims on my child’s behalf, hereby release Hawaii School for Girls at La Pietra, Coconut Wireless Network LLC, and each of its board of directors, officers, employees, administrators, volunteers, agents, representatives, management staff, designees and TechZone coaches (collectively referred to as the “School”) from any and all claims (whether known or unknown), liability, causes of action, injury, damages (including physical and economic), costs, expenses, compensation and attorneys’ fees directly or indirectly arising out of, related to, or connected with my child’s participation in the Program. I further agree to hold the School harmless from any such claims. I expressly agree that this waiver is intended to be as broad and inclusive as is permitted by the laws of the State of Hawaii and if any portion is held invalid or unenforceable, the remaining portions shall, notwithstanding, continue in full legal force and effect. The terms of this release and waiver shall be construed according to the laws of the State of Hawaii. I agree that the terms of this release and waiver bind me, my child, my heirs, assigns, executors and administrators. I hereby grant the School permission to take photographs and video, digital, audio and recording of my child. I further grant the School the right to use my child’s image or likeness as portrayed in photographs, video recordings, audio recordings, and other digital images, for educational, marketing, and publicity purposes, including, but not limited to, in or on news broadcasts, webcasts, telecasts, advertising materials, websites, social media, and any other publication, without providing any compensation or further notice to my child or me. I hereby release the School from any liability associated with the taking, recording, digitizing, publication, disclosure, and use of my child’s image or likeness. I understand that this consent may be revoked or withdrawn, but such withdrawal or revocation must be in writing and delivered to [email protected]. I understand that such withdrawal shall be effective only prospectively from the date the School receives the request to withdraw consent. Any actions already taken by the School in reliance on the consent under this agreement shall be covered by the terms of this agreement.

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To keep the integrity of the program and ensure a smooth experience for all participants, please note that all sales are final. We regret that we cannot offer refunds. Thank you for your understanding and support.