2022 MFS K-6 Summer Program Registration Form

Montessori Family School 2022 Summer Program Registration

All 1st - 6th grade eligible; MFS-enrolled KB students also welcome!
Student Information
Student's Name *

First Name Last Name
Birth Date *

Month Day Year
Current School
Grade (current) *
Gender

Male Female Non-binary
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent/Guardian Information
Name *

First Name Last Name
Cell Number *

Area Code Phone Number
Home Number

Area Code Phone Number
E-mail *
Emergency Information
Emergency Contact's Name *

First Name Last Name
Relationship
Phone Number *

Area Code Phone Number
Alt. Phone Number

Area Code Phone Number
MFS will provide snack daily. Does the student have any food allergies or sensitivities?
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is the student prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Montessori Family School (MFS) during the selected camp. In exchange for the acceptance of said child’s candidacy by Montessori Family School, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless MFS and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against MFS, including all teachers and affiliates, all participants, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named student. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Montessori Family School and its affiliates including Directors, Teachers, and Staff to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered session(s).

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature *
Date *

Month Day Year
Date
Session Registration and Payment

Please choose an option below. Beneath each option is the session theme; academic worktime is potentially available in the mornings.

Registration Options *

Session 1 (1 Week) - 9:00am-4:00pm: June 20 - June 24 $ 450.00

Making music videos

Session 2 (1 Week) - 9:00am-4:00pm: June 27 - July 1 $ 450.00

Makers lab/STEM

Session 3 (2 Weeks) - 9:00am-4:00pm: July 5 - July 15 $ 850.00

Script to Screen: Make a Movie

Session 3 (2 weeks) [ONE WEEK ONLY] $ 450.00

PLEASE DO NOT CHOOSE THIS OPTION BEFORE SPEAKING TO MFS ADMIN. Being present for only one week, your child will not be able to participate in each part of the process. Please contact MFS to discuss.

Session 4 (1 Week) - 9:00am-4:00pm: July 18 - July 22 $ 450.00

Gardening - Week 1

Session 5 (1 Week) - 9:00am-4:00pm: July 25- July 29 $ 450.00

Gardening - Week 2

Enrolled MFS families only: Bill my account Free

Please contact caroline@montessorifamily.com to charge the on-file ACH information. Please note that your spot in camp is not guaranteed until payment is received.

Enter coupon

Total $ 0.00

loading smart payment buttons...

Session 1 // June 20 - June 24

1 Week

Making Music Videos

From Bowie to Beyonce, Aha! to OK Go: music videos integrate songs and imagery to tell a story or create a mood. We will be writing and/or adapting songs, then designing and recording age appropriate music videos. The videos will be available on invitation-only links so family and friends can all enjoy them.
Session 2 // June 27 - July 1

1 Week

Makers/STEAM Experimental Journey

Join us as we experiment with science, building, and art. We will build inventions and create imaginative art in our maker space, and see what happens when we conduct scientific experiments. This will be a place to make some mistakes and messes, as well as scientific discoveries and some imaginative creations.
Session 3 // July 5 - July 15

2 Weeks

From Script to Screen: Write and Produce a Movie in 2 Weeks

Come make movie magic! The students will create their own characters, collaborate on the script, design and create simple costumes and sets and then we film the movie. The completed movie will be available on an invitation only link so family and friends can all enjoy the show.
Sessions 4 & 5 // July 18 - 22 & July 25 - 29

2 1-Week sessions

Gardening and Horticultural Exploration

As an avid gardener, Gloria has designed a curriculum revolving around summer edible plants to sow in the garden. Working in the garden will take advantage of the students' time outdoors. It, also, gives students the opportunity to learn basic gardening skills, such as seed spacing, and how to use garden tools properly and safely. More importantly, students will have a better understanding of nature's role in our daily diets and food preparation skills, which will last a lifetime.
Terms and Conditions

Upon sign-up, MFS will consider that the family has committed, in writing, to attend this camp. 10% discount if camp tuition is paid in full by April 1, 2022. Until April 30th, in the event of cancellation MFS retains $100 per week as a non-refundable deposit. After May 1st, no tuition refund is available. Camp enrollment is not transferrable.
Should be Empty:

Montessori Family School 2022 Summer Program Registration

Session Registration and Payment