Travel Clearance Form 2021-2022
PHCA follows Safe Travels Hawaii Guidelines for all travelers. If you travel outside of the State of Hawaii, please complete this form PRIOR to retuning to school.

Students who traveled out of the State of Hawaii must also provide a copy of their boarding pass which shows arrival date AND one of the following in order to be cleared to attend school:

1) their Negative COVID test
2) COVID-19 Vaccine Card - if fully vaccinated, or
3)  Proof of completion of quarantine

-Only ONE survey form should be submitted per household.
-Complete information for 2nd and 3rd Child on this same form as needed.
-Please answer the questions as they relate directly to each student.
-Parent or Guardian must review and verify all information before submitting.  
-Please submit form by 11:59PM on the day BEFORE you plan to return to school in Hawaii.
-Any additional documentation required should be emailed to phcaforms@phcaschools.org at the same time.
(i.e. Negative COVID test, vaccine card if fully vaccinated)
-Students will not be allowed to attend school without this clearance
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Email *
Name of PARENT/GUARDIAN reviewing and verifying information being submitted. *
Student1 FIRST Name *
Student1 LAST Name *
Student1 Grade *
TRAVEL1:  What date did you return from travel out of the State of Hawaii? (month/day/year) *
MM
/
DD
/
YYYY
TRAVEL1: Select the choice that applies to you *
Second child that attends PHCA? *
Student2 FIRST Name
Student2 LAST Name
Student2 Grade
Clear selection
TRAVEL2:  What date did you return from travel out of the State of Hawaii? (month/day/year)
MM
/
DD
/
YYYY
TRAVEL2: Select the choice that applies to you
Clear selection
Third child that attends PHCA?
Clear selection
Student3 FIRST Name
Student3 LAST Name
Student3 Grade
Clear selection
TRAVEL3:  What date did you return from travel out of the State of Hawaii? (month/day/year)
MM
/
DD
/
YYYY
TRAVEL3: Select the choice that applies to you
Clear selection
CONTINUE HERE TO COMPLETE CHECKLIST
Mahalo!
For everyone’s health and safety, and especially to keep our campus open, PHCA is required to remain in compliance with all State Mandates regarding COVID-19. Let's continue to be cautious and considerate as we pray for this pandemic to end.
A copy of your responses will be emailed to the address you provided.
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