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Montessori at the Old Schoolhouse

Enrollment Contract

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Enrollment Contract
Child’s Name
Birth Date
Date Format: MM slash DD slash YYYY
School year of enrollment
Address
Street Address City State / Province / Region ZIP / Postal Code
Parent/Guardian 1 Name
Email
Mobile Phone
Home Phone
Work Phone
Parent/Guardian 2 Name
Email
Mobile Phone
Home Phone
Work Phone

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EMERGENCY CONTACTS: Person other than parent to be notified in an emergency when a parent is not available
Child’s Name
EC #1 Name
Phone
Address
EC #2 Name
Phone
Address
Names and phone numbers of persons other than parents to whom the child may be released:
Child’s Name
Name 1
Phone
Name 2
Phone
Name 3
Phone
Name 4
Phone
Name 5
Phone
Name 6
Phone

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MEDICAL FORM
Child’s Name
Preferred physician for emergency treatment
Dr’s Phone
Preferred hospital
Hospital Phone
Health Insurance Co.
Health Insurance ID #
My child is allergic to (please check all that apply):
- Bee Sting
- Milk Products
- Nuts by a) ingesting b) inhaling c) touch
- Peanuts by a) ingesting b) inhaling c) touch
- Wheat
- Other Allergies
Other Allergies (please specify)
The following medications have been prescribed for my child & should be administered as instructed:
- Epi Pen
- Antihistamine
- Inhaler
- Nebulizer
- Other
Other (please specify)
My child has the following conditions
This condition is chronic:
- YES
- NO
In order to safeguard the health of the children and staff, I agree to keep my child home if any of the following symptoms are displayed:
In order to safeguard the health of the children and staff, I agree to keep my child home if any of the following symptoms are displayed:

☀Unexplained rash
☀Ear discharge
☀Vomiting/ diarrhea
☀Unusual irritability
☀Red or inflamed throat
☀Cough of more than ten days
☀Above normal body temp
☀Any contagious disease, e.g. pink eye
☀Thick, greenish nasal discharge of more than seven days

In the event my child develops symptoms of illness at school, I will pick him/her up within the hour unless other arrangements are made. I will allow my child to return to the school ONLY if my child has been symptom-free without the use of Children’s Tylenol/Advil/et cetera for at least 24 hours.

Before the start of the school year, I agree to submit one of following along with this Enrollment Contract: A) A medical form with immunization records from child’s physician completed within the last 12 months (an updated form is required annually) OR B) A signed letter explaining our family’s religious/philosophical approach to immunizations and health care.

I understand that prescription medication cannot be given without a copy of the doctor’s prescription and should be brought to school in the prescription bottle, and that over-the- counter medications (e.g. Children’s Advil) cannot be given without a note from the parent/ guardian with dosage amount and times to be given.

I herby give Montessori at the Old Schoolhouse and its staff permission to secure and provide any medical or emergency care for my minor child that the school deems necessary, including but not limited to calling a doctor for medical or surgical care, or having my child taken to the hospital via ambulance. I understand that a conscientious effort will be made to locate me (and/ or my partner) before any action will be taken, but if it is not possible to locate us, this expense will be accepted and paid by us. I agree to hold the school and its staff harmless from any liability resulting from any action or omission made in good faith and resulting from said medical care.
Child’s Name
In order to safeguard the health of the children and staff, I agree to keep my child home if any of the following symptoms are displayed: ☀Unexplained rash ☀Ear discharge ☀Vomiting/ diarrhea ☀Unusual irritability ☀Red or inflamed throat ☀Cough of more than ten days ☀Above normal body temp ☀Any contagious disease, e.g. pink eye ☀Thick, greenish nasal discharge of more than seven days In the event my child develops symptoms of illness at school, I will pick him/her up within the hour unless other arrangements are made. I will allow my child to return to the school ONLY if my child has been symptom-free without the use of Children’s Tylenol/Advil/et cetera for at least 24 hours. Before the start of the school year, I agree to submit one of following along with this Enrollment Contract: A) A medical form with immunization records from child’s physician completed within the last 12 months (an updated form is required annually) OR B) A signed letter explaining our family’s religious/philosophical approach to immunizations and health care. I understand that prescription medication cannot be given without a copy of the doctor’s prescription and should be brought to school in the prescription bottle, and that over-the- counter medications (e.g. Children’s Advil) cannot be given without a note from the parent/ guardian with dosage amount and times to be given. I herby give Montessori at the Old Schoolhouse and its staff permission to secure and provide any medical or emergency care for my minor child that the school deems necessary, including but not limited to calling a doctor for medical or surgical care, or having my child taken to the hospital via ambulance. I understand that a conscientious effort will be made to locate me (and/ or my partner) before any action will be taken, but if it is not possible to locate us, this expense will be accepted and paid by us. I agree to hold the school and its staff harmless from any liability resulting from any action or omission made in good faith and resulting from said medical care.
Signature of parent
Date
Date Format: MM slash DD slash YYYY

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TUITION
Child’s Name
I agree to pay an annual tuition of
See current rates immediately below.

Primary Tuition:
5 days/week – $4800.00 ($480.00 / 10 installments)
4 days/week – $4500.00 ($450.00 / 10 installments)
3 days/ week – $ 3850.00 ($385.00 / 10 installments)

Toddler Tuition (or any child still in diapers in primary classroom):
5 days / week – $ 5200.00 ($520.00 / 10 installments)
4 days / week – $ 4900.00 ($490.00 / 10 installments)
3 days / week – $ 4250.00 ($ 425.00 / 10 installments)
Check the box beside the statement:
- As part of the Enrollment requirements, I agree to pay one months installment as a non-refundable deposit along with this signed contract.
I understand that the school offers the option to pay tuition over the course of the year. chosen the following option for paying the annual tuition:
- Full payment on or before September 1st
- Monthly payments on or before the 1st of each month
I understand and agree to the following terms regarding the tuition and its payment:
☀ Checks are made payable to Montessori at the Old Schoolhouse. ☀ A $15.00 late fee will be charged for tuition received after the fifth day of the month (regardless of whether it falls on a weekend or holiday). After the 15th of the month, my child will no longer be able to return to school until tuition is paid. ☀ A charge of $40.00 will be assessed for any check returned by the bank. ☀ I am responsible for the tuition for the entire school year even if I withdraw my child early. ☀ Tuition includes holidays, vacation days and snow days. Because the expenses of the school continue regardless of the absence of the child, there are no credits, refunds or make-up days without prior approval.
Signature of parent
Date
Date Format: MM slash DD slash YYYY

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SCHOOL CLOSINGS
Child’s Name
I understand and agree to the following terms regarding the tuition and its payment:
During inclement weather, Montessori takes its lead from the Red Hook Central School District: if they delay or close, so does Montessori (unless I am otherwise instructed via the Montessori website, the emailed newsletter, text or phone call). I understand there are no make- up days for school closings, and that delays follow this schedule: ☀ 1 hour delay = 9:30am-12:00pm session ☀ 2 or 3 hour delay = 10am – 12pm session
Signature of parent
Date
Date Format: MM slash DD slash YYYY

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PICK UP & DROP OFF
Child’s Name
I understand and agree to the following regarding dropping off kids:
☀ Drop off begins 10 minutes before the school day begins and continues for 20 minutes – i.e. 8:20-8:40 am. ☀ If you arrive early, please wait in the car with your child. The teachers are getting the classroom ready for the day and cannot accommodate early arrivals. ☀ Please wait in the car with your child as a teacher will come to the car door and help your child out. ☀ Arriving late is disruptive to the routine of the entire school, please commit to arriving on time. If you are late, you must park in the lot and walk your child to the door. Wait until a teacher greets the child before leaving.
I understand and agree to the following regarding picking up kids:
☀ In good weather, your child will be outside at dismissal. We will try to be aware of your arrival and have your child ready for you. ☀ A late fee of $5.00 will be charged beginning at 11:45 am. An additional $10.00 will accrue every 15 minutes thereafter until the child is picked up. ☀ No child will be released to any person besides the parents without written authorization. If someone else will be picking up, written authorization needs to be given to a teacher at the beginning of class or accompany the individual who is picking up. That person also must have photo ID to pick up the child.
Signature of parent
Date
Date Format: MM slash DD slash YYYY

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FIELD TRIPS & EXCURSIONS
Child’s Name
I agree to permit the participation of my child in the portrayals of school activities in film, slides, photographs and other reproductions and allow their use on publicity and other representations of the school.
Signature of parent
Date
Date Format: MM slash DD slash YYYY

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SNACKS & FLOWERS
Child’s Name
When given a reminder from the teachers, I agree to provide a healthy snack for the entire class for one week, along with a small bouquet of flowers for the children to arrange and display in the classroom, two to three times annually.
Signature of parent
Date
Date Format: MM slash DD slash YYYY

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PROBATION & DISMISSAL
Child’s Name
I understand the school reserves the right to discharge a student and terminate the enrollment contracts at any time if the school decides that dismissal is in the best interest of the school and/ or child. Even though careful screening is done prior to a child’s admittance, it is still possible he or she may not be able to cope in a group situation. For this reason, ALL CHILDREN ARE ACCEPTED ONLY ON A TENTATIVE BASIS FOR THE FIRST SIX WEEKS. If at the end of that period it is thought he or she would do better to wait until later in the year or that another environment would be more suitable, the parent will be contacted for a conference to discuss the matter.
Signature of parent
Date
Date Format: MM slash DD slash YYYY

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IDEMNIFICATION
Child’s Name
In consideration of the acceptance of my child as a student at Montessori at the Old Schoolhouse, and having satisfied myself that supervision and attention to safety are prudent and reasonable, I agree to indemnify and hold harmless the school and its staff against all claims and demands made by or on behalf of my child, including through or by me, my spouse, or the legal guardian of the child.
Signature of parent
Date
Date Format: MM slash DD slash YYYY

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Montessori at the Old Schoolhouse • 557 West Kerley Corners Road • Tivoli, NY 12583 • 845-758-3434 • jstivoli@aol.com

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