Date of Application
Age on Start Date
Date of Birth
Place of Birth
City of Employment
City of Employment
Status of Parents
Married Separated Divorced Single Widowed
What are the visitation arrangements for your child?
If there has been a custody decision, please list the name(s) of persons NOT PERMITTED to pick up your child from the school
Please list below, in preferential order, anyone other than yourself who has authorization to pick up your child. These individuals will be contacted in an urgent situation, including a medical emergency, in the event that parents cannot be reached.
Please choose local residents.
Primary Account Owner for Billing
Where and for how many days/hours per week?
How long has he/she been attending?
We would like to know
How long does your child usually nap?
Does your child have any special blankets to sleep with?
What is your child’s favorite snack?
Does your child have special needs?
List three words that come to mind as his/her strengths?
Is there anything you do not want your child to have for snack? (sweets, ice cream etc.)
What activities/toys does your child most enjoy?
Does your child enjoy playing alone, or does he/she always prefer the company and attention of other adults or children?
How would you rate your child’s capacity to follow instructions?
Has your child been toilet trained, if so, for how long (Toddlers only)?
Health Related Information
Details of allergy to specific medication or food items etc.
Does your child have any medical history of illness or medications? ( i.e. seizures, high fevers, etc.) Please explain:
**Please make sure to provide a copy of your child’s Universal Health Form and Immunization Records**
I hereby grant permission for my child to use all of the play equipment and participate in all physical activities conducted at the school.
In the event of an extreme medical emergency, as deemed by the director or other responsible school staff member, paramedics or medical personnel will be notified IMMEDIATELY to initiate medical attention for the child. All efforts will be made to notify the parents or guardian or persons named above for emergency contact, immediately.
Due to insurance regulations, injured or ill children must be transported to a hospital, when necessary, by paramedics or ambulance. The child cannot be transported by school transport or school personnel.
Upon immediate need for medical attention for your child the undersigned hereby gives consent to X-ray examinations, anesthetics, medical or surgical diagnosis or treatment, and hospital care to be rendered to said minor upon the advice of a physician and/ or surgeon licensed under the provisions of the Medical Practice Act.
All costs related to my child’s emergency treatment(s) will be borne by me.
allow/do not allow my child’s image to be displayed on social media and/or school communications (like newsletter and School Facebook page) for informational/educational purposes.
At least one parent must sign below. If parents are separated or divorced, both parents signatures are required. In such a case when you press “SEND” both parents will receive an email with this application as an attachment. The attachment (application) should be printed and signed by both parents and then submitted to the school.
Please attach a current copy of your child’s immunization records. If your child’s immunization schedule is not up to date in accordance with his/her age, please attach an explanation from your physician.
Please click on the chosen program and which extended hours, if needed.
Attendance Program Chosen
Please check appropriate option/Days.
Other Hours, please specify
By signing this form, I am enrolling my child in a program at New Horizons Montessori. My commitment at New Horizons Montessori will start on the Start Date mentioned above. If for any reason I need to remove my child from the program, I will give 1 month (30 days) notice to the office (in writing) notifying our plans to leave. In this case, the deposit paid will be used towards the last month of attendance when proper written notice is received. If the required notice is not given, the deposit is liable for forfeiture.
I understand that during July and August, the school operates as a Summer Camp. During this time, my child may or may not attend Camp either completely or partially. If the child attends partially, the fees will be charged based on the Summer Camp rules. If the child attends full summer camp, he/she can continue to pay on a monthly rate. In such a case, there may be additional charge(s) for specials that are offered during the Summer Camp.
I understand that my child’s monthly tuition installment calculation is based on a full year, quoted and payable in monthly installments for ease of payment. The monthly installment is not based on the number of attendance days in each month; some months will have more attendance days than others. Full tuition is due regardless of the number of days my child actually attends school. There are no refunds for missed days, whatever the reason, nor will there be compensatory days for absence.
I understand that New Horizons Montessori may discontinue my child’s attendance at any time if it determines that my child’s behavior is detrimental to the well-being of other students/staff. I agree to follow the school policies as described in the Parent Handbook, including the School Calendar.
I am remitting a payment that constitutes a Registration Fee of $75 and $600 Deposit Fee, per your enrollment requirement. The deposit is non-refundable after acceptance for registration has been completed, and it will not be used for adjustments of other dues.
If parents are separated or divorced, both parents signatures are required. In such a case when you press “SEND” both parents will receive an email with this application as an attachment. The attachment (application) should be printed and signed by both parents and then submitted to the school.
By typing my signature and sending this form using the internet medium I acknowledge that I have read and understood all the information provided; I agree and understand that my electronic signature is equivalent to my manual written signature.