Lor-Jon Montessori School
367 Spring Rd.
Elmhurst, Illinois 60126
(630) 993-0109
SUMMER SESSION APPLICATION 2015
I ______do hereby make application for the admission of
______D/O/B ____/____/____ as a pupil in the Lor-Jon Montessori School for the month(s) of
(please circle one)
June (June 8- July 3) 9-Noon July (July 6-July 31) 9-Noon June & July (June 9- July 31) 9- Noon
Days M T W Th F (Please circle the days that your child will attend)
Home Address______
______
Telephone No.______Cell No.______
Names to call in case of emergency:
______( _ _ )______(____)______
Name Telephone No. Cell Phone No.
______( _ _ )______(____)______
Name Telephone No. Cell Phone No.
If neither parent can be contacted I/we authorize the school administration to take such emergency action as may be deemed necessary.
I/we understand that the terms and agreements of the contract for the 2014-2015 school year is fully enforced and agreed upon.
I/we hereby give consent for my child/children to be taken outside for education and play.
I/we grant permission for the use of photographs or digital images in which my/our child may appear to be used for educational and public relations purposes , such as articles in papers, slides of film, or school web page.
Please list any people who you authorize to pick up your child/children from school. ( If a person not on your list will be picking up your child/children, we must receive written, signed, and dated authorization to release your child/children.)
______( _ _ )______(____)______
Name Telephone No. Cell Phone No.
______( _ _ )______(____)______
Name Telephone No. Cell Phone No.
Tuition for the summer session is due on the first day of each session:
3-6 Year old classes 9-Noon Toddler Class (2 year olds)
3 days a week $430.00 2 days a week $420.00
4 days a week $455.00 3 days a week $445.00
5 days a week $480.00 4 days a week $470.00
I agree, in consideration of the acceptance of my child as a pupil in the Lor-Jon Montessori School, indemnify the school, administration and staff against any claims and demands made by or on the behalf of:
______
Child’s Name
______
Signature of parent or guardian Date
______
Signature of parent or guardian Date
Date Application Received______