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).
a month in advance on the first of each month, whether I receive a
per month for meals for my child. I understand that if I choose to
bring meals from home the school is not responsible for its nutritional value or for meeting my child’s daily food needs. A $5 late fee is added each day after the 5th of the month. I understand there will be no tuition deductions for holidays, illnesses, vacations, or other reasons.
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 obtain emergency medical treatment and to transport my child for emergency treatment from the doctor listed below or to any licensed physician at any hospital.
Copy of Shot Records and a Doctor’s Statement are required. Also, a hearing and vision screening record for children 4 years and older is required. Please sign the Authorization to Release Form and we will fax this to your doctor.
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.