Sunita’s Montessori School
1022 East 3900 South, Salt Lake City, UT - 84124.
Office (801) 268 3944 Fax (801) 268 3949
ADMISSION AGREEMENT 2010 - 2011
Date of Enrollment___________________________________
Name of Child__________________________________________________ Sex_____________
Date of Birth__________________________
Childs Daily School Time Schedule.
Days : Mon. Tue. Wed. Thurs. Fri.
Time:
Previous School Attended_________________________________________________________
Child’s Siblings Name and Age_____________________________________________________
Child’s Health (any allergies)_______________________________________________________
Physical Mental or developmental conditions which would require special attentions or any special needs____________________________________________________________________
Any other remarks________________________________________________________________
Home Address____________________________________________________________________
Home Telephone________________________
Mother’s/Guardian’s Name_________________________________________________________
Employer________________________________________________________________________
Employer’s Address_______________________________________________________________
Employer Telephone__________________________________ Mother’s Cell_______________
Father’s/Guardian’s Name_________________________________________________________
Employer________________________________________________________________________
Employer Address_________________________________________________________________
Employer Telephone_________________________________ Father’s Cell__________________
Child’s primary source of emergency health care__________________________________________
Address_______________________________________________Phone No.___________________
Child’s primary source of emergency dental care__________________________________________
Address_______________________________________________Phone No.___________________
Emergency Contacts (other than parents and people living in the child’s home):
Name Relationship to child Address Phone No.__________
1.____________________________________________________________________________
2.____________________________________________________________________________
3.____________________________________________________________________________
Individuals authorized to pick up the child:
1.___________________
2.___________________
3.___________________
If there is any change in the Home address, Employers address, Emergency contacts, Authorized people to pick up your child and change of telephone numbers of the above , You are responsible to let the office know about it and make the changes in the Admission Agreement Form. Initial_________.
If for some reason some your child has to be picked up by a person other than the ones authorized you are responsible for calling the office giving verbal authorization or a written note.
That person has to present his I.D. a copy of which will be taken and put in the child’s file. Initial________
Who is responsible for Tuition Payment
Mother Father Others Initial________
Tuition should be paid in full by the 5th of each month in advance for that month. Initial________
(if 5th falls on a weekend please make the payments the following Monday.)
Late fee from 6th to 10th of each month will be $ 25.00 (No exception). Initial____________
(if 10th falls on a weekend please make the payments the following Monday)
If payment is not received by the 10th of each month child will not be permitted to come to school till full tuition payment is made with the late fee. (No exception). Initial_______________
For payments to be made by the State, Parents you are responsible to submit your paper work to the state well in advance.
Tuition is NOT DEDUCTIBLE for days child is absent from school or the days when the school is closed for holidays . Initial________________
In case of emergency or serious illness, when parents cannot be reached immediately, I hereby authorize the provider to obtain emergency medical care and /or provide emergency medical transportation.
Signature of parent or guardian________________________________________
I hereby give the provider permission to transport my child in the provider’s vehicle for the following:
1. to and from school 2. Field trips 3. Other.
Signature of parent or guardian__________________________________________