Club Keiki

This is the application form for Club Keiki at Central Pacific College(CPC). After sending in your application you may expect a reply within 3 business days. If you do not receive a reply within 3 business days, we humbly ask that you send another application form.

Country Code

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Parent's Email Address ^*

【Emergency contact】

Parent/Guardian’s Name ^*

Relationship ^*

Phone number in Hawaii ^*

Email address ^*

【Optional】

Photos of your child's experience in the program will be taken and made available online. If you would like to buy photos of your child's experience in the program, please check "Yes, I would like to purchase photo packages of my child in the program." below. If you check yes, the photo fee matching your child's length of enrollment in the program will automatically be included in your overall tuition fee. CPC will send an online link to these photos within 2 months after the end of the program. ^*
Yes, I would like to purchase photo packages of my child in the program.No, I am not interested in buying a photo package.

Cost based on weeks enrolled
１week	$20
2weeks	$25
3weeks	$30
4weeks	$35
5weeks	$40

【Others】

Payment methods (Registration) ^*
Credit CardWire Transfer (additional $35)Personal ChecksAlready paid online

Payment methods (Tuition) ^*
CashCredit CardWire Transfer(additional $35)Personal Checks

How did you learn about CPC? ^*
Website FriendInternet/SNSBlogAgentOthers

CPC Family Package ^*
*Please submit attached application form
to info@cpchawaii.com
1 Adult + 1 Child：Homestay1 Adult + 1 Child：Condominium Residence(Shared Condo)1 Adult + 2 Children：Homestay1 Adult + 2 Children：Condominium ResidenceNone

PROMO CODE

Questions
*If your child has participated in the Club Keiki before, please mention it in the box below when you submit your question. A discount will be applied to your registration fee.
**If more than one family member will be enrolled in a program at CPC, please mention it in the box below when you submit your question. A discount will be applied to the second child's tuition fee.
***If you will be staying with a host family, please mention it in the box below when you submit your question.

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Please read the refund/cancellation policy.
I have read and agree to the refund/cancellation policy. ^*
(You must check this box in order to submit your application.)