Enrollment Application Form

CHILD ENROLLMENT CARD
CHILD'S LAST NAME
CHILD'S MIDDLE NAME
CHILD'S FIRST NAME
NICKNAME
SEX
BIRTH DATE (M-D-Y)
Date Format: MM slash DD slash YYYY
PARENT/GUARDIAN FIRST NAME
PARENT/GUARDIAN MIDDLE NAME
PARENT/GUARDIAN LAST NAME
HOME PHONE
CELL PHONE
CELL PHONE
PARENT/GUARDIAN ADDRESS
Street Address City State / Province / Region ZIP / Postal Code
PROGRAM APPLYING FOR:
CLASS SCHEDULE:
- FULL DAY (8:00AM – 3:00PM)
- HALF DAY (8:00AM – 12:00PM)
- EXTENDED DAY (7:00AM – 6:00PM)
CLASS SCHEDULE:
- FULL DAY (8:00AM – 3:00PM)
- EXTENDED DAY (7:00AM – 6:00PM)
EXTENDED CARE HOURS
7:00AM - 7:45AM 12:30PM ONWARDS FOR HALF DAY CHILDREN 3:30 - 6:00PM FULL DAY $10.00 PER HOUR/$2.50 PER EVERY QUARTER HOUR EXTENDED CARE IS OFFERED FOR MORNING/AFTERNOON. THESE FEES ARE CHARGED SEPARATE, PRE-PAYMENT IS REQUIRED TO RESERVE A SPOT. ATTENDANCE IS REQUIRED FOR ALL 5 DAYS EITHER ON A FULL OR HALF DAY SCHEDULE.
LUNCH
- YES
- NO
LUNCH IS PROVIDED BY THE PARENT. SCHOOL PROVIDES 1 SNACK FOR HALF DAY. 2 SNACKS FOR FULL DAY CHILDREN
PARENT 1/GUARDIAN
PARENT 1/GUARDIAN SOCIAL SECURITY NO.
PARENT 1/GUARDIAN DRIVER'S LICENSE NO/STATE ISSUED
CHILD'S LIVING ARRANGEMENTS
PARENT 1/GUARDIAN NAME
PARENT 1/GUARDIAN EMPLOYER NAME
PARENT 1/GUARDIAN WORK HOURS
PARENT 1/GUARDIAN BUSINESS PHONE NO.
PARENT 1/GUARDIAN ADDRESS
Street Address City ZIP / Postal Code
EMAIL PARENT 1/GUARDIAN
PARENT 2/GUARDIAN
PARENT 2/GUARDIAN SOCIAL SECURITY NO.
PARENT 2/GUARDIAN DRIVER'S LICENSE NO/STATE ISSUED
CHILD'S LIVING ARRANGEMENTS
PARENT 2/GUARDIAN NAME
PARENT 2/GUARDIAN EMPLOYER NAME
PARENT 2/GUARDIAN WORK HOURS
PARENT 2/GUARDIAN BUSINESS PHONE NO.
PARENT 2/GUARDIAN ADDRESS
Street Address City ZIP / Postal Code
EMAIL PARENT 2/GUARDIAN
PERSONS TO NOTIFY IN CASE OF EMERGENCY (OTHER THAN PARENT/ GUARDIAN)
EMERGENCY CONTACT 1 NAME
EMERGENCY CONTACT 1 RELATIONSHIP
EMERGENCY CONTACT 1 DAYTIME PHONE NO.
EMERGENCY CONTACT 1 STREET ADDRESS
EMERGENCY CONTACT 2 NAME
EMERGENCY CONTACT 2 RELATIONSHIP
EMERGENCY CONTACT 2 DAYTIME PHONE NO.
EMERGENCY CONTACT 2 STREET ADDRESS
PERSONS AUTHORIZED TO PICK UP CHILD
AUTHORIZED PERSON 1 NAME
AUTHORIZED PERSON 1 DRIVER'S LICENSE NO. & STATE
AUTHORIZED PERSON 1 RELATIONSHIP
AUTHORIZED PERSON 1 DAYTIME PHONE NO.
AUTHORIZED PERSON 2 NAME
AUTHORIZED PERSON 2 DRIVER'S LICENSE NO. & STATE
AUTHORIZED PERSON 2 RELATIONSHIP
AUTHORIZED PERSON 2 DAYTIME PHONE NO.
AUTHORIZED PERSON 3 NAME
AUTHORIZED PERSON 3 DRIVER'S LICENSE NO. & STATE
AUTHORIZED PERSON 3 RELATIONSHIP
AUTHORIZED PERSON 3 DAYTIME PHONE NO.
NAME OF PUBLIC OR PRIVATE SCHOOL CHILD ATTENDED PREVIOUSLY, IF ANY
FIRST DATE OF ATTENDANCE (M-D-Y)
WITHDRAWAL DATE (M-D-Y)
SPECIAL OR STATE INSTRUCTIONS AND /OR REQUIREMENTS
To Parents:

IN CASE OF INJURY

If your child is injured at the Montessori Explorer, you many want to consult with your family physician to
determine whether the nature of the injury requires medical attention, vaccination (against Hepatitis A, Hepatitis B, tetanus, or other infectious disease) or other care.

INSURANCE INFORMATION

If your child is injured while at Montessori Explorer and requires medical attention, your health insurance will be the primary source responsible for payment of the cost of treatment for your child.

IF YOUR CHILD IS BITTEN

Child development research indicates that approximately 50% of all children enrolled in child care will be bitten. Toddlers especially will often use biting as a form of communication. Montessori Explorer will strive to minimize biting accidents. However, it is highly likely that your child will be bitten at some time. If this should occur, We will do our best to comfort your child and care for his/her needs immediately. We will also inform the parents of the biter and work with them and their child to change this behavior.

IF YOUR CHILD BITES ANOTHER CHILD

Biting is very serious and is unacceptable. If your child bites, Montessori Explorer will work with you to develop a plan to correct the problem. However, if the biting is aggressive, breaks skin, does not lessen within a reasonable period of time, or diverts an inordinate amount of time of the provider away from the other children and program implementation, Montessori Explorer may have to temporarily dis-enroll your child until the biting diminishes.

IMMUNIZATION OF CHILDREN

Parents should make certain that their child is immunized pursuant to the schedule recommended by the American Academy of Pediatrics to protect against polio, measles, mumps, rubella (German measles), whooping cough (pertussis) diphtheria, tetanus, and Haemophilus (Hib) infections. Montessori Explorer supports the Academy's recommendations for Hepatitis B (HBV) immunization of infants and school age children 11-12 years old who have not previously received the vaccine, and the recommendation for chicken pox (varicella zoster) immunization. Without these immunizations, many of these childhood illnesses can cripple or kill. If your child's immunizations are not completed following the recommended schedule, Montessori Explorer may exclude your child for the protection of the other children until such immunizations are current. Per new laws, if your child is not immunized they will not be accepted to school.

SCHOOL ENROLLMENT GUIDELINES AND POLICIES

All children must abide by the health and safety guidelines setforth for the whole school. Any child that displays aggressive behavior that puts other children in danger will be removed from school. Any parent that does not abide by school policies and guidelines will be asked to meet with administration to resolve any issues but if all remedial measures are lost, the child will be terminated from school.

I have read and agree to abide by the above.
IN CASE OF INJURY If your child is injured at the Montessori Explorer, you many want to consult with your family physician to determine whether the nature of the injury requires medical attention, vaccination (against Hepatitis A, Hepatitis B, tetanus, or other infectious disease) or other care. INSURANCE INFORMATION If your child is injured while at Montessori Explorer and requires medical attention, your health insurance will be the primary source responsible for payment of the cost of treatment for your child. IF YOUR CHILD IS BITTEN Child development research indicates that approximately 50% of all children enrolled in child care will be bitten. Toddlers especially will often use biting as a form of communication. Montessori Explorer will strive to minimize biting accidents. However, it is highly likely that your child will be bitten at some time. If this should occur, We will do our best to comfort your child and care for his/her needs immediately. We will also inform the parents of the biter and work with them and their child to change this behavior. IF YOUR CHILD BITES ANOTHER CHILD Biting is very serious and is unacceptable. If your child bites, Montessori Explorer will work with you to develop a plan to correct the problem. However, if the biting is aggressive, breaks skin, does not lessen within a reasonable period of time, or diverts an inordinate amount of time of the provider away from the other children and program implementation, Montessori Explorer may have to temporarily dis-enroll your child until the biting diminishes. IMMUNIZATION OF CHILDREN Parents should make certain that their child is immunized pursuant to the schedule recommended by the American Academy of Pediatrics to protect against polio, measles, mumps, rubella (German measles), whooping cough (pertussis) diphtheria, tetanus, and Haemophilus (Hib) infections. Montessori Explorer supports the Academy's recommendations for Hepatitis B (HBV) immunization of infants and school age children 11-12 years old who have not previously received the vaccine, and the recommendation for chicken pox (varicella zoster) immunization. Without these immunizations, many of these childhood illnesses can cripple or kill. If your child's immunizations are not completed following the recommended schedule, Montessori Explorer may exclude your child for the protection of the other children until such immunizations are current. Per new laws, if your child is not immunized they will not be accepted to school. SCHOOL ENROLLMENT GUIDELINES AND POLICIES All children must abide by the health and safety guidelines setforth for the whole school. Any child that displays aggressive behavior that puts other children in danger will be removed from school. Any parent that does not abide by school policies and guidelines will be asked to meet with administration to resolve any issues but if all remedial measures are lost, the child will be terminated from school. I have read and agree to abide by the above.
PARENT/GUARDIAN SIGNATURE
DATE
Date Format: MM slash DD slash YYYY
PARENT/GUARDIAN SIGNATURE
DATE
Date Format: MM slash DD slash YYYY

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Montessori Explorer

CHILD ENROLLMENT CARD

PARENT 1/GUARDIAN

PARENT 2/GUARDIAN

PERSONS TO NOTIFY IN CASE OF EMERGENCY (OTHER THAN PARENT/ GUARDIAN)

PERSONS AUTHORIZED TO PICK UP CHILD

To Parents:

@