Summer Camp Application | PJ Summer Camp at NH Montessori

EMERGENCY MEDICAL RELEASE FORM

I hereby grant permission for [ Child Name ] 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 acting director, 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.

Signature of parent or guardian responsible for payment for medical services rendered:

Print Name:-

Signature of parent or guardian responsible for payment for medical services rendered:

Print Name:-

NEW HORIZONS MONTESSORI

59 Cranbury Road, Princeton Jct., NJ 08550

Tel: (609) 275-8666

Summer Camp Enrollment Application

Gender

Status of parents:

IDENTIFICATION & EMERGENCY
INFORMATION

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.

The following section is only for our teacher's to get to know Pre-K and Toddlers better

Please Let Us Know.........

Does your child have any medical history of illness or medications? (i.e. seizures, high fevers, etc.) Please explain:

Special Instructions/Comments…

Camp Attendance

Week/ Dates

SCHEDULE CHANGES

USE OF SPRINKLER

POLICY ON EXPULSION

SUMMER CAMP TUITION

At least one parent must sign this application.
If parents are separated or divorced, both parents must sign this application and submit as a hard copy by filling it and printing from this page.

EMERGENCY MEDICAL RELEASE FORM

Signature of parent or guardian responsible for payment for medical services rendered:

Signature of parent or guardian responsible for payment for medical services rendered:

Contact Us

Please send us your message, and we’ll get back to you.

All (*) marked fields are mandatory

NEW HORIZONS MONTESSORI

59 Cranbury Road, Princeton Jct., NJ 08550

Tel: (609) 275-8666

Summer Camp Enrollment Application

Gender

Status of parents:

IDENTIFICATION & EMERGENCY INFORMATION

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.

The following section is only for our teacher's to get to know Pre-K and Toddlers better

Please Let Us Know.........

Does your child have any medical history of illness or medications? (i.e. seizures, high fevers, etc.) Please explain:

Special Instructions/Comments…

Camp Attendance

Week/ Dates

Week 1 ( July 1 – July 5)

Week 2 ( July 1 – July 5)

Week 3 ( July 1 – July 5)

Week 4 ( July 1 – July 5)

Week 5 ( July 1 – July 5)

Week 6 ( July 1 – July 5)

Week 7 ( July 1 – July 5)

Week 8 ( July 1 – July 5)

Week 9 ( July 1 – July 5)

SCHEDULE CHANGES

USE OF SPRINKLER

POLICY ON EXPULSION

SUMMER CAMP TUITION

At least one parent must sign this application. If parents are separated or divorced, both parents must sign this application and submit as a hard copy by filling it and printing from this page.

EMERGENCY MEDICAL RELEASE FORM

Signature of parent or guardian responsible for payment for medical services rendered:

Signature of parent or guardian responsible for payment for medical services rendered:

Contact Us

Please send us your message, and we’ll get back to you.

All (*) marked fields are mandatory

IDENTIFICATION & EMERGENCY
INFORMATION

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.

At least one parent must sign this application.
If parents are separated or divorced, both parents must sign this application and submit as a hard copy by filling it and printing from this page.