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Grace Montessori School

GMS-Enrollment Form

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GMS ADMISSIONS CONTRACT
Child’s Name
First Last
Email

You will be receiving a copy of this form submission
SMS (TEXT) ALERTS
I select to receive SMS (text) notifications sent on behalf of Grace Montessori School. I agree to abide by the terms and conditions of my cellular provider and am 100% responsible for any charges incurred by my cellular provider for receiving any SMS messages sent by Grace Montessori School.
- Yes
- No
Parent/Guardian 1 Cell #
Cell Provider
Parent/Guardian 2 Cell #
Cell Provider
MEDIA RELEASE AND PHOTOGRAPHS
Photographs may be taken of my child within the classroom and in-house field trips for use in articles and information distributed to Grace Montessori School families.
- Yes
- No
I grant permission for my child to be photographed or featured in any video, television, audio recording or broadcast in association with Grace Montessori School that will be made available to the public.
- Yes
- No
COMPLIANCE POLICY
Please check the box beside the statement*
- I will pick up my child as soon as possible in the event that Grace Montessori School calls to inform me that my child is ill. This is in compliance with state regulations.
Please check the box beside the statement*
- I understand and acknowledge that Grace Montessori School is operating under the license of a religiously exempt child day center.
Please check the box beside the statement*
- I further agree that in the event that any person in our household, even if they do not attend Grace Montessori School, contracts a communicable disease, I will inform Grace Montessori School immediately.
TRIP PERMISSION
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- I hereby give permission for my child to be transported via Williams Bus Line to and from field trips away from school grounds during the school year, unless the school receives written notice from me to the contrary.
Please check the box beside the statement
- I hereby give permission for my child to be transported to the field trips by a licensed and insured driver. I understand that when my child is transported in the car, the driver will follow all safety precautions, including the use of seat belts. I will provide a safety seat as requested by Virginia State Law.
Please check the box beside the statement
- I understand that if I do not wish for my child to participate in a specific trip, the school will make every effort to find space in another class in the school. If no space is reasonably available, I understand that it may be necessary to keep my child home the day of the trip.
** Please note that Virginia State Law does NOT require safety seats on the school bus.
TRANSPORTATION AUTHORIZATION
Children can only be released to people on the list.
Persons authorized to pick up
Person NOT authorized to pick up

Appropriate legal paperwork is required if a parent is listed
Please check the box beside the statement
- I understand that I must inform Grace Montessori in writing of any changes. In the event of an emergency, I will contact Grace Montessori School to give my permission.
PARENT HANDBOOK ACKNOWLEDGEMENT
Please check the box beside the statement*
- I have received a Parent Handbook which contains important information for all parents who enroll their children in Grace Montessori School. The Parent Handbook is a composite of policies and procedures that will make your experience at out school more enjoyable. We hope that you will understand the need for the policies and procedures and that the ideas and suggestions will facilitate communication while helping us to provide a supportive and responsive environment for all families. Please keep your handbook for future reference. It is an important part of our Enrollment Agreement that will aid in the understanding and compliance with all policies and procedures. I/We acknowledge receipt of the Parent Handbook. I/We understand that by signing this we also agree to abide by the rules and regulations contained in the handbook.

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EMERGENCY HEALTH FORM - PART 1
PARENT INSTRUCTIONS If your child does not have health concerns please fill out Part I only and sign at the bottom as “disclaimer” of any known allergies or medical conditions. If your child has health concerns or requires long-term medications, a physician must complete and sign Part II.
Child’s Name
First Last
Child's SSN
Date of Birth
Date Format: MM slash DD slash YYYY
Age
Gender
Parent/Guardian Name
First Last
Daytime Phone
Cell Phone
Parent/Guardian Name
First Last
Daytime Phone
Cell Phone
EMERGENCY CONTACT INFORMATION: List two local emergency contacts in the event parents/guardians cannot be reached.
Emergency Contact #1
Name Daytime Phone Cell Phone Address
Emergency Contact #2
Name Daytime Phone Cell Phone Address
MEDICAL AND ALLERGY INFORMATION (in accordance with DSS #80.0 & 8.0)
List any chronic problems or pertinent developmental information and any special accommodations that are needed for your child.
Known Allergies
Other medical conditions
RECOMMENDATIONS AND RESTRICTIONS
Special Diet
Strenuous activity/Physical Education
Other
INSURANCE INFORMATION
Insurance Company
Policy ID#
Pediatrician/Physician
Phone
Address
Street Address City ZIP / Postal Code
Dentist/Orthodontist
Phone
Address
Street Address City ZIP / Postal Code
AUTHORIZED TO SEEK MEDICAL ATTENTION
Please check the box beside the statement
- I hereby authorize Grace Montessori personnel to seek medical attention for my child in the event of an emergency. I, as a parent/guardian, also authorize Grace Montessori personnel to transport my child to the appropriate medical facility in the event that urgent/emergency care is necessary. The hospital and its medical staff have my authorization to provide treatment which a physician deems necessary for the well being of my child.
PARENT AUTHORIZATION AND DECLARATION
Please check the box beside the statement
- I understand that minor accidents or injuries will be treated at the school and that I will be notified of any treatment. I also understand that specific medical information may be shared with school staff as deemed necessary. The emergency information and health history are correct to the best of my knowledge, and the person herein described has permission to engage in all activities except as noted on this form.
TERMS AND CONDITIONS OF ENROLLMENT

1. Application and Capital Improvement Fee are non-refundable.

2. This is a school contract. In order to be released from further tuition obligations a thirty (30) day written notification of your intention to withdraw your child is required. Withdraws must contain an original signature: fax, email, or verbal notice is not accepted. Withdraws are effective from the date the school receives the notice. You are responsible for tuition for the remainder of the thirty (30) days. This contract is valid from date accepted by Grace Montessori.

3. Tuition rates can be changed with sixty (60) day notice to parents.

4. The child and parents agree to abide by the rules and regulations set forth for the health, safety and welfare of the child.

5. All group or program placements of the children are solely at the discretion of the school and are based upon appropriate developmentally level. Placement of a child is subject to change at any time.

6. Grace Montessori reserves the right to deny, cancel, sever or suspend a child’s enrollment if deemed in the best interest of the child or of the school.

7. All tuition payments would are due by the 15th of each month. Late fees will be applied for tuition received after the 15th in accordance with the GMS handbook.

8. No refunds will be made for days missed due to illness, inclement weather, disaster, or holidays.

9. Should the school be closed for any reason on a specified day of the week a child is scheduled to attend, no make-up or additional day of attendance will be given. Should a child be absent on a specified day of the week scheduled to attend, no make-up or additional day of attendance will be given.

10. Additional days or hours of attendance beyond the specified program currently enrolled will be billed at the extra hours rate of $10 per hour or any portion thereof. All additional time of attendance must be approved in advance by the school administration.

11. First tuition payment is due on the child’s first day of enrollment. Tuition will be prorated for the month for any student starting after the first week of the month.

13. Following the receipt of your letter of intention to withdraw your child per the guidelines in Term #2 you will receive a departure letter from Grace Montessori. This letter will detail your financial obligation to the school which will include any tuition owed for extra hours/occasional care and your monthly tuition in addition to any other outstanding fees.

15. We hereby promise to meet the tuition rate schedule and dates due. Failure to comply with payment on correct dates will be dealt with as stated above. No transfer of records will be granted until financial obligations to the school have been met.

Grace Montessori School admits students of any race, religion, creed, color and national or ethnic origin. Grace Montessori School considers the records of all students to be confidential information available to a child’s parents or guardians upon request. Requests will only be released to other centers or agencies upon the signed request from the parent or guardian, and only after all accounts are paid in full.
1. Application and Capital Improvement Fee are non-refundable. 2. This is a school year (10-month) contract. In order to be released from further tuition obligations a thirty (30) day written notification of your intention to withdraw your child is required. Withdraws must contain an original signature: fax, email, or verbal notice is not accepted. Withdraws are effective from the date the school receives the notice. You are responsible for tuition for the remainder of the thirty (30) days. This contract is valid from date accepted by Grace Montessori. 3. Tuition rates can be changed with sixty (60) day notice to parents. 4. The child and parents agree to abide by the rules and regulations set forth for the health, safety and welfare of the child. 5. All group or program placements of the children are solely at the discretion of the school and are based upon appropriate developmentally level. Placement of a child is subject to change at any time. 6. Grace Montessori reserves the right to deny, cancel, sever or suspend a child’s enrollment if deemed in the best interest of the child or of the school. The school will follow the discipline policy as outlined in the Grace Montessori Parent Handbook. 7. Enrollment is Automatic Deduction program through Fauquier Bank (ACH-FB) must be completed prior to the first day of attendance. Children may not attend classes until ACH agreement has been filled out. 8. No refunds will be made for days missed due to illness, inclement weather, disaster, or holidays. 9. Should the school be closed for any reason on a specified day of the week a child is scheduled to attend, no make-up or additional day of attendance will be given. Should a child be absent on a specified day of the week scheduled to attend, no make-up or additional day of attendance will be given. 10. Additional days or hours of attendance beyond the specified program currently enrolled will be billed at the extra hours rate of $12 per hour or any portion thereof. All additional time of attendance must be approved in advance by the school administration. 11. All ACH-FB payments are to be made on the fifth (5th) of the month and are non-refundable. A late fee of $50 will be added to all payments after the fifth (5th) calendar day of the month. A fee of $50 will be added to all returned checks or returned ACH-FB payments. Grace Montessori reserves the right to add a collection fee of thirty percent(30%) on any delinquent account balance that is referred to any outside agency/attorney for collections. It is further agreed that you will be responsible for all court costs plus interest of 1.5% per month at 18% per annum. 12. First tuition payment is due on the child’s first day of enrollment. Tuition will be prorated for the month for any student starting after the first week of the month. 13. Following the receipt of your letter of intention to withdraw your child per the guidelines in Term #2 you will receive a departure letter from Grace Montessori. This letter will detail your financial obligation to the school which will include any tuition owed for extra hours/occasional care and your monthly tuition in addition to any other outstanding fees. 14. If your child is not picked up on time, you will be charged an overtime rate. Parents arriving after 4:30 pm will be charged $2 per minute for the first ten (10) minutes, $4 per minute for 11-20 minutes, $10 per minute for 21+ minutes - based on the clock in the school office. 15. We hereby promise to meet the tuition rate schedule and dates due. Failure to comply with payment on correct dates will be dealt with as stated above. No transfer of records will be granted until financial obligations to the school have been met. Grace Montessori School admits students of any race, religion, creed, color and national or ethnic origin. Grace Montessori School considers the records of all students to be confidential information available to a child’s parents or guardians upon request. Requests will only be released to other centers or agencies upon the signed request from the parent or guardian, and only after all accounts are paid in full.
Please check the box beside the statement*
- I acknowledge that I have read and understood the above terms and conditions.
Parent Name*
Signature*
Date
Date Format: MM slash DD slash YYYY
Parent Name*
Signature*
Date
Date Format: MM slash DD slash YYYY
PROOF OF IDENTITY VERIFICATION
In an effort to help identify missing children, the Virginia Department of Social Services requires us, as a school offering child care, to ask for information pertaining to a child’s previous, if any, care. Parents are also asked to present the school with proof of the child’s identity and age. In compliance with this regulation, Grace Montessori School asks that you provide us with the requested information. Proof of a child’s identity and age may include a certified copy of a child’s birth certificate, birth registration card, notification of the child’s birth (hospital, physician or midwife record) or a passport. In the case of adoption, a placement agreement or other proof of the child’s identity from a child placement agency is also acceptable. We ask that you provide us with this information at the time of your child’s enrollment, no later than his or her first day. Please understand we do not need to keep the original document. We only need to transfer the information on to the enrollment application.
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