Enrollment Application

Phone

Parents or Legal Guardians Information:

Person 1- Mother or Guardian 1:

Person 1 Name *

First Middle Last

Person 1 Address *

City State Zip

Person 1 Email *

Person 1 Phone *

Person 1 Cell Phone Provider

Person 1 Business Phone

Person 1 Occupation & Place of Employment:

Person 2- Father or Guardian 2:

Person Two Name

First Middle Last

Person 2 Address

City State Zip

Person 2 Email

Person 2 Phone

Person 2 Cell Phone Provider

Person 2 Business Phone

Person 2 Occupation & Place of Employment

Child lives with: *

Marital Status of Parents:

Who has legal status of child if not parents?

Student Information

Student Name *

Nick Name

Check if address is same as:

Person 1 Person 2

Student Address *

City State Zip

Student Home Phone *

Gender *

Female Male

Date of Birth *

Any special notes?

Student Program

Program *

Shedule *

2 Days Per Week 3 Days Per Week 5 Days Per Week

Which days will your child attend *

Monday Tuesday Wednesday Thursday Friday

Will your child be attending extend care?

Check if your child be attending extend care

Estimated arrival time

Estimated departure time

How did you hear about us?

Reference

I was Referred By:

Notes

Are the any special notes or exceptions pertaining to anything above?

Emergency Contacts:

Emergency Contact 1 *

Name Relationship to child Address Phone

Those authorized to pick up child

Same as above

1 *

Name Relationship to child Address Phone

Out of state contact:

Out of state contact

Name Relationship to child Address Phone

Child's Siblings:

Names, ages, and schools attending:

Allergies and Food Sensitivities

Is the child allergic to any medication?

Check if the child allergic to any medication

Is the child allergic to any foods?

Check if the child allergic to any foods

Does the child have any other allergies?

Check if the child have any other allergies

Does the child have any special sensitivities

Check if the child have any special sensitivities?

Annual Health Assessment

Child's Name *

Child DOB: *

Date of Child’s Last Exam:

Name of Child’s Doctor:

Doctor’s Office Address: *

Doctor’s Office Phone Number:

Is the child current with immunizations?

Has the child been diagnosed with any of the following chronic illnesses or medical conditions:

Check here if NONE

medical conditions

Asthma

Diabetes

Seizures

Heart Problems

Other

Has the child been diagnosed with any of the following disabilities:

Check here if NONE

Has the child been diagnosed with any of the following disabilities:

Hearing Impairments

Visual Impairments

Developmental Delay

Emotional Problems

Physical Impairment

Other

Is your child on a behavior plan we should be aware of to ensure success?

NONE

Please explain: *

Medications your child takes:

NONE

Please explain: *

Any additional health information:

NONE

Please explain: *

Any instructions for your child’s daily care:

NONE

Please explain: *

Parent/Guardian eSignature *

Type your name

Current Date

1. I understand and agree that BMM has a soft inside shoe policy. I must provide a pair of soft shoes for my child while they are insidethe classroom to stay in their cubby at school. Acceptable inside shoes are- slippers or a shoe with a soft sole. I understand and agree that I also need to provide my child with a pair of outside shoes for recess

2. I understand and agree that I need to supply and bring all the items listed in clause 21 of parent handbook.

3. I understand and agree that BMM has an extra clothes and extra bedding bin that teachers will use for your child if they run out of extra clothes or do not have bedding. If your child gets sent home with clothing or bedding labeled “BMM’s EXTRA” you have 2 school days to wash and return these items to school. If you do not return them you will be charged $1 per day until we get them back.

4. I understand and agree that Blooming Minds Montessori focuses on fostering the child’s independence. For this reason, BMM allows the child to feed themselves, dress themselves, wipe their own noses, wash their own hands, get their own water, serve themselves and their friends snack, unpack and prepare their own lunch, use paint and other art supplies on their own, explore sand, dirt, and water on their own, etc. While we encourage children to do these things on their own, teacher’s do help and step in when needed but for these reasons we ask that parents provide bibs and clothing that you do not mind your child getting messy in.

5. I understand and agree that BMM teachers are willing to give their personal cell phone number out to parents for communication purposes. However, this is with the intention that parents respect teacher’s personal time and only contact teachers on their cell phones M-F 7am7pm. If you would like your child’s teacher’s cell phone number you may email them to request it. If parents abuse this and contact teachers outside of the allotted time we will take this privilege out of our contract.

6. I understand and agree that teachers at BMM may apply lotion, lip ointments, hand sanitizer, diaper rash cream, care for hair, care for nails, etc. to help care for each child.

*Please check if there is something you wish the teachers do not apply or care for during school:

Lotion Lip Ointments Hand Sanitizer Diaper Rash Cream Care for hair Care for nails Other

7. I understand and agree that the schedule I have selected for my child above is the schedule that Blooming Minds is reserving for my child. I understand that these are the only dates and times my child may attend so the school can stay in correct student to teacher ratio. Blooming Minds does not allow “make-up” days- meaning, if my child misses a day in their schedule, they may not make it up on a day that is not included in their schedule. If for any reason you need your child to come an extra day, BMM needs a 48-hour notice so we can check to see if we have space for an extra child that day. If we do permit your child to come for an extra day, an extra day charge will be added to your invoice. I understand and agree that I may not choose a week to week schedule for my child. BMM schedules are set up on a monthly basisif you select a 3-day schedule, your child may come for 3 days only and it must be the same three days every week. If you need to change your child’s schedule, you may submit a written request and we will return a form to you with approval or denial of the schedule change.

8. I understand and agree that I will need to provide alternative care for my child on the days the school is closed (stated in the annual calendar). Blooming Minds Montessori has based tuition on an annual school year basis, this means we have added up all of the days in the 12-month year that the school is open and figured out tuition based on those days only.

Payment and fee Policy: I understand and agree that monthly tuition is due the 1st of each month. I agree to pay the amount listed on the tuition sheet for my child’s program. Your account will be charged a $25 late fee and $10 per day until payment is submitted in full when it is not submitted by the 1st. A $25-dollar fee will be charged for returned checks and credit card decline. Annual fees include $100 material and $50 activity which I pay every school year. I agree to pay the annual fees 30 days after submitting this application. I agree to pay the $100 registration onetime fee when I submit this application. *

Parent/Guardian eSignature

Emergencies: In case of emergency or serious illness, I hereby authorize Blooming Minds Montessori to obtain emergency medical care and/or provide emergency medical transportation *

Parent/Guardian eSignature

Withdrawing Policy: I understand and agree that I am responsible to give Blooming Minds Montessori a paid 30 days’ notice if I decide to withdraw my child before the school year ends. If I withdraw my child early, I agree that all fees are non-refundable *

Parent/Guardian eSignature

Parent Handbook: I have read and understand and agree to all terms in Blooming Minds Montessori’s parent handbook. *

Parent/Guardian eSignature

Photos: I give Blooming Minds permission to take photos of my child while attending Blooming Minds. Further, I give permission for Blooming Minds to utilize these photos in their marketing efforts, including brochures, posters, websites, newsletters, social media, and blogs. Names of children will not be associated with pictures for marketing efforts. *

Parent/Guardian eSignature

I hereby enroll: *

Student Name

into Blooming Minds Montessori Preschool. The laws of the state of Utah govern this enrollment agreement. I understand and agree with all terms on all pages of this enrollment contract and parent handbook. *

Parents/Guardian Signature