Gettysburg Montessori Preschool Application

The Gettysburg Montessori Preschool is a tuition-based private program. The program operates on the same calendar as Gettysburg Area School District. To submit an application to the school, children must be 3 years old and fully bathroom trained.

Please complete our enrollment packet for each student enrolling in the program. Please print clearly. NOTE: Students are not officially enrolled until all required forms have been submitted.

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Office Use Only

Student Name:______

Date Application Received______Start Date______

Birth Certificate: Date of Birth:______

Enrollment Application Form:

Student Information:

School Year Applying For:______

Full Legal Name of Student:______

Nickname:______

Date of Birth:______Gender:______

Address:______

Parent Information:

With which parent does the child live? Please explain any custody arrangements:______

______

Mother’s Name:______Employer:______

Address:______

Email:______

Phone: (Home):______(Cell):______(Work):______

Father’s Name:______Employer:______

Address:______

Email:______

Phone: (Home):______(Cell):______(Work):______

Other Emergency Contacts:

Name:______Phone:______

Copy of Student’s Immunizations

Please attach a copy of the student’s immunizations to this form.

Copy of Student’s Birth Certificate

Please attach a copy of the student’s birth certificate to this form.

Photo/Video Release:

Dear Parent/Guardian: Throughout the year there are occasions when the school will want to take pictures/videos of your child participating in activities. We may use these for our school webpage or local newspapers. We are requesting that you check two of the below.

I give my consent for the school to use pictures/videos of my child on the school webpage.

I give my consent for the school to use pictures/videos of my child in local newspapers.

I do not give my consent for the school to use pictures/videos of my child on the school webpage.

I do not give my consent for the school to use pictures/videos of my child in local newspapers.

Emergency and Health Information Form:

Child’s Full Legal Name:______

Date of Birth:______

Child’s Address:______

Parent’s/Guardian’s Full Name:______

Mother’s Phone: (Home):______(Cell):______(Work):______

Father’s Phone: (Home):______(Cell):______(Work):______

Other Emergency Contacts:

Name:______Phone:______

Please list any serious allergies, conditions (including physical or emotional) or restrictions the student

has:______

______

Does your child have any health concerns such as allergies, asthma, or any other condition that we must know about in order to make decisions on the proper medical care for your child in case of an emergency?______

______

Emergency Release

Gettysburg Montessori Charter School will attempt to reach the parent/legal guardian or one of the people listed as an emergency contact, but if none of these people can be reached, school personnelhave permission to use discretion in securing medical aid in an emergency. It is understood that neither Gettysburg Montessori Charter School nor the person responsible for obtaining the medical aid will be responsible for the expense incurred.

Parent/Guardian Signature:______Date:______

Enrollment Choice:

I am enrolling my child______in the Gettysburg Montessori private preschool beginning______

for:(check one) (Date)

_____M-F Full Day

_____M-F Half Day

_____MWF Full Day

_____MWF Half Day

_____TR Full Day

Full day programs begin at 8:40 and end at 3:10; half day programs end at 11:45. Students may be dropped off as early as 8:15.

Emergency weather days are the only days that can be made up with prior notification to the office. August and June’s rates will be prorated.

Tuition per month:

M-F Full Day$610

M-F Half Day$400

MWF Full Day$376

MWF Half Day$250

TR Full Day$259

Payment is due the first of each month. If you are unable to make a monthly payment, contact the office immediately, we will try to work with you; however, if 2 months payments are missed, you will lose your spot in preschool. You may elect to pay in full for the year.

______

Parent’s Signature