Summer 2023 Enrollment Form

CHILD RELEASE & INFORMATION
Will you be carpooling with another family? If you do not know at the time of enrollment, you may email museumschool@fwmsh.org at a later date with additional information.*

YesNoNot Sure
Please list the names of the children (other than siblings) in your carpool.
Each individual designated below will be assigned a unique pin number in Procare. Child Care Regulation requires two emergency contacts OTHER THAN THE CHILD'S PARENTS/GUARDIANS.

Emergency contacts and individuals authorized for pick up do not have the ability to download the Procare app and access student information. They will provide their unique pin number to a Museum School Staff member at drop off and pick up.

Emergency contacts are automatically authorized to pick up/drop off, so there is no need to enter emergency contacts twice. Please do not enter the child's parents/guardians in any of the contact spaces below.
As a currently enrolled family, do you wish to make changes to your family's EMERGENCY CONTACTS for Summer 2023?
Emergency Contact #1 *

First NameLast Name
Emergency Contact #1*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact #1*
Please enter a valid phone number.
Relationship to Child*
Emergency Contact #2 *

First NameLast Name
Emergency Contact #2 *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact #2*
Please enter a valid phone number.
Relationship to Child*
As a currently enrolled family, do you wish to make changes to your family's AUTHORIZED PERSONS FOR DROP OFF/PICK UP for Summer 2023?
Authorized Pick Up #1

First NameLast Name
Authorized Pick Up #1*
Please enter a valid phone number.
Relationship to Child*
Authorized Pick Up #2

First NameLast Name
Authorized Pick Up #2*
Please enter a valid phone number.
Relationship to Child*
Authorized Pick Up #3

First NameLast Name
Authorized Pick Up #3*
Please enter a valid phone number.
Relationship to Child*
Authorized Pick Up #4

First NameLast Name
Authorized Pick Up #4*
Please enter a valid phone number.
Relationship to Child*
Authorized Pick Up #5

First NameLast Name
Authorized Pick Up #5*
Please enter a valid phone number.
Relationship to Child*
I authorize Museum School to release my child ONLY with the persons listed above. There will be NO EXCEPTIONS. Children will only be released to a parent/guardian, emergency contact or authorized person for pick up after verification of Procare Pin Number (provided by Museum School) and/or photo ID. If I need to add additional persons or remove anyone on this list, I will email Museum School at museumschool@fwmsh.org with the request in writing.*
Parent/Guardian Signature*

Clear
Parent/Guardian Name*

First NameLast Name
Date*

MonthDayYear
Date

Summer 2023 Museum School Medical Documentation Form

Museum School is regulated by the Texas Health and Human Services and follows all standards and requirements regarding student records.
(CURRENT STUDENTS) I verify:*

My child is a current 2022-2023 student. Therefore, Museum School will utilize my child's current Fall/Spring 2022-2023 file for required medical documentation, including Immunizations and the FARE form (if applicable). These forms are on file and do not need to be submitted again for Summer 2023 classes.If there are any changes to my child's health, I will provide Museum School with critical care information prior to the first day of my child's Summer class.
My child:*
Name of preschool, prekindergarten or other school where the required immunization record (or a signed an notarized affidavit exemption) is on file.*
Phone Number of School*
Please enter a valid phone number.
Address of School*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
NEW STUDENTS WHO DO NOT ATTEND ANOTHER SCHOOL: Please upload a copy of your child's CURRENT IMMUNIZATION RECORD or a DATED AND NOTARIZED Official Exemption Affidavit from the Texas Department of State Health Services exempting the child from Texas immunization requirements.

If you do not have access to the required document at the time of enrollment, please email a SCANNED copy of the document to registermuschool@fwmsh.org by JUNE 1, 2023 with "CHILD'S FIRST NAME AND LAST INITIAL - RECORDS" in the SUBJECT of the email. (Please do not send a photo of the document or the child's complete medical record from a health portal. Visit the Museum School website to see an example of acceptable immunization records.)
Please upload a copy of your child's CURRENT IMMUNIZATION RECORD or a DATED AND NOTARIZED Official Exemption Affidavit from the Texas Department of State Health Services exempting the child from Texas immunization requirements HERE.

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Cancelof
Health Statement*

My child has been examined within the past 12 months by a health care professional and is able to participate in Summer 2023 Museum School.My child has NOT been examined within the past 12 months by a health care professional. I will submit a Health Statement signed by a physician prior to June 1, 2023 in order for my child to attend summer classes.
Parent/Guardian Signature*

Clear
Parent/Guardian Name*

First NameLast Name
Date

MonthDayYear
Date
Should be Empty:

	Morning (9:30am-12:00pm)	Afternoon (1:00pm-3:30pm)
June 19-22: Dinosaur Days (CLASSES CLOSED - WAITLIST ONLY)
June 26-29: Dinosaur Days (CLASSES CLOSED - WAITLIST ONLY)
July 10-13: Around the River (CLASSES CLOSED - WAITLIST ONLY)
July 17-20: Space Bound (CLASSES CLOSED - WAITLIST CLOSED)
July 24-27: Down by the Sea (CLASSES CLOSED - WAITLIST CLOSED)

	Morning (9:30am-12:00pm)	Afternoon (1:00pm-3:30pm)
June 19-22: Dinosaur Days (WAITLIST ONLY)
June 26-29: Dinosaur Days (AM CLOSED - WAITLIST ONLY; PM OPEN)
July 10-13: Around the River (AM CLOSED - WAITLIST ONLY; PM OPEN)
July 17-20: Space Bound (CLASSES CLOSED - WAITLIST CLOSED)
July 24-27: Down by the Sea (CLASSES CLOSED - WAITLIST ONLY)

	Morning (9:30am-12:00pm)	Afternoon (1:00pm-3:30pm)
June 19-22: Dinosaur Roundup (CLASSES CLOSED - WAITLIST ONLY)
June 26-29: Dinosaur Roundup (CLASSES CLOSED - WAITLIST ONLY)
July 10-13: Wild Wetlands (CLASSES CLOSED - WAITLIST ONLY)
July 17-20: Space Explorers (CLASSES CLOSED - WAITLIST CLOSED)
July 24-27: Down by the Sea (WAITLIST CLOSED)

	Morning (9:30am-12:00pm)	Afternoon (1:00pm-3:30pm)
June 19-22
June 26-29
July 10-13
July 17-20
July 24-27

Summer 2023 Museum School Enrollment Form

IMPORTANT

CLASS REQUEST & PARENT AUTHORIZATION FORM

SCHOLARSHIPS: If you are interested in applying for a Summer 2023 Scholarship for your child, please click HERE to complete the application. The Scholarship Form must be completed with the Enrollment Form.

CHILD RELEASE & INFORMATION

Summer 2023 Museum School Medical Documentation Form