Please list the names and telephone numbers of other persons to whom we may contact in case of emergency and to whom your child may be released. (State law requires that we have this information on file).
with no deductions for absence or holidays. If tuition is not paid prior to the close of business on the first day of attendance, a Late Payment fee of $5.00 a day may be added to my child’s tuition
I release the school, its directors and staff from any liability for injuries, accidents or illnesses occurring while attending a school program. I authorize the school to provide transportation for my child for all school activities when applicable and give my permission for my child to participate in water activities when under school supervision. I give permission for pictures and videos to be taken of my child and for them to be posted on the school’s website and/or social media.
I plan to leave my child at school between the hours of
Monday thru Friday
or Part Time - M T W T F (circle days of program)
In the event that I cannot be reached to make arrangements for emergency medical care at the time of illness or accident, I authorize Five Star Montessori to take my child to:
Or to a licensed physician at any Hospital
Parents’ Statement: My child has been examined by a health care professional within the past year and they have stated that my child is able to participate in a childcare program.
Copy of Shot Records or
Parents’ Statement: My child’s shot record and hearing and vision screening are current and is on file at the school that my child attends.
Please list any special problems that your child may have such as allergies, existing illness, injuries during the past 12 months, any medication prescribed for long-term continuous use, behavior issues or any other information that the staff should be aware of or check the statement below:
I have received the parent’s handbook or agree to view it on the school's website at
www.FiveStarMontessori.com. I understand that verbal conversations are subject to misinterpretation
and I will rely on the written policies in the parent handbook.