Enrollment Date______
Withdrawal Date______
Northlake Montessori
Registration Form-PS/PK
Child’s Name______Date of Birth______
Parent’s Names______
Days of Enrollment______Hrs of Enrollment______
HEALTH
Can your child participate in all school related activities?______
Any limitations?______
Allergies or other health concerns?______
ACADEMIC
What are your goals for your child this year?______
Do you have any concerns about your child’s level of learning? ______
OTHER INFORMATION
What does your child enjoy doing? ______
Does your child have any fears? ______
Has your child been to school before?____ If so, what kind of experience was it?______
Has your child had any special problems or difficult behaviors? ______
Do you have any special abilities/resources you would share with the class/school?______
Please describe your child to help us better understand how to care for them______
Enrollment Date______
Northlake Montessori
Child’s Information Sheet
Child’s Name______Birth Date______
Mom______Home Phone______
Address______City______Zip______
Work Phone______Cell Phone______E-mail______
Dad______Home Phone______
Address______City______Zip______
Work Phone______Cell Phone______E-mail______
Is there anyone who cannot pick-up your child? ______
Name______Relationship______
Reason______
Emergency Contacts: Please list, in order, whom the school should contact in the event of an emergency, when neither parent can be reached. Written permission is required in the State of Washington for an adult other than a legal guardian to remove a child from a childcare facility. The following are authorized to remove your child on any occasion from the school:
Name______Relationship______
Home Phone______Work Phone______Cell Phone ______
Name______Relationship ______
Home Phone ______Work Phone ______Cell Phone ______
Name ______Relationship ______
Home Phone______Work Phone______Cell Phone______
Out of State Disaster/Crisis Contact
Name______Relationship______
Home phone______Work Phone______Cell Phone______
Parent Signature______Date______
Parent Signature______Date______
Medical Release: I hereby give permission that my child may be given emergency treatment by a qualified staff member of Northlake Montessori. I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. In the event I cannot be contacted, I further consent to the medical, surgical and hospital care, treatment, and procedures to be performed for my child by a licensed physician or hospital when deemed immediately necessary or advisable by the physician to safeguard my child’s health.
Parent’s Signature______Date______
Family Doctor______Phone______
Date of last physical______
Family Dentist______Phone______
Family Hospital______Phone______
Allergies?______
Serious illnesses, accidents or surgery?______
______
Any Chronic medical condition?______
Parenting Plan: Married__ Divorced__ Single__ Joint Custody__ Guardianship__
We routinely take pictures of the children and use the pictures for staff training, for art projects and to hang on the walls in the rooms and in the hallways at Northlake.
We would also like to use pictures of the children for advertising and on our website.
_____ Yes, I agree to allow Northlake to use my child’s pictures.
_____ No, please do NOT use pictures of my child for advertising and/or website.
I have read and understand the Northlake Montessori Parent Handbook.
Parent Signature______Date______
Parent Signature______Date______
Northlake Montessori
Tuition Agreement
Child’s Name:______
Parent’s Name:______
Days receiving care: M______T_____ W_____ TH_____ F______
Agreed Arrival & Departure time (within 10hrs.) ______
I agree to pay the current tuition rate weekly, and in advance for child care.
I agree to pay the registration fee (non-refundable) of $50.00 per child, upon registration and yearly by September 1st when I register my child/ren for the upcoming year and agree to the current rate.
Payments need to be made no later than the Monday of each week. Tuition will not be reduced if my child/ren fails to attend school, regardless of the cause. I am entitled to one week of absence per year, payment-free.
A $25.00 LATE FEE will be charged if payment has not been received by the end of the week. If I pay a co-pay I will also be charged $25.00 on the 5th of the month if my payment has not been received.
If for any reason my check is returned for insufficient funds, I will be assessed a $25.00 penalty and must make arrangements for immediate payment.
If Northlake Montessori has not received my tuition by the 15th of the month, my child/ren may not attend until such payments are made or arrangements for payments have been made with the office.
If a balance is left on my account after my child/ren is no longer attending the school, a $25.00 late fee will be added to my balance each month unless at least a $50.00 payment is received. If the school has not received a payment in 90 days, I will be responsible for all attorney fees and reasonable costs of collection for any outstanding amounts due under this agreement.
If I am unable to pick up my child by 6:30p.m., a late fee of $1.00 per minute will by added to my account, payable with my next tuition payment.
In the event I wish to withdraw my child, I shall give Northlake Montessori two weeks notice in writing of such intent and I agree to pay two weeks of tuition following the receipt by the school of such notice.
Yes, I have received and read my copy of Northlake’s Parent Handbook.
Parent’s Signature______SSN______
Parent’s Signature______SSN______