Please fill out the following application. You will hear back from the MililaniĀ Center Director.


Child's Name

Date of Birth

Home Address

Mailing Address

Home Phone

Email

Mother's Name

Date of Birth

Employer Name

Occupation

Business Phone

Cell Phone

Father's Name

Date of Birth

Employer Name

Occupation

Business Phone

Cell Phone

Child's Physician

Physician's Phone Number

Medical Insurance Carrier

Policy Number

Allergies

Tuition payment will be made by
ParentArborOpen DoorsFirst-to-WorkPauahi Keiki ScholarsKeiki O Ka AirnaFederal

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