In Person Learning Pod Registration Form

Learning Pod Registration Form

Welcome to Quantum Montessori a Heart Centered Brand! Thank you for choosing Quantum for your child’s educational needs. Please fill out our form for each child you would like to enroll at Quantum. Your deposit is required to hold your child's spot during registration. You will be asked to complete a longer enrollment package if a spot is immediately available in your desired program. In the event that a program is currently full, we will place you on a waiting list and follow up with you as soon as an opening becomes available.

Student Information
This is your student identification number. Please keep it safe, as it will stay with your child for the entire duration of their enrollment and beyond.
First Name
First Name
Middle Name
Last Name
Date of Birth
Last Name
Curent Grade Level
Does your child have any allergies or medical conditions?
If yes, please specify
Is your child currently taking any medication?
If yes, please specify

Previous Education
Are you transferring from another school? If yes, please fill out the following information.
Reason for leaving other school and choosing a learning pod:
Previous School 1
School Name
City
State
Dates of Attendance

MM/DD/YYYYMM/DD/YYYY
Previous School 2
School Name
City
State
Dates of Attendance

MM/DD/YYYYMM/DD/YYYY
Previous School 3
School Name
City
State
Dates of Attendance

MM/DD/YYYYMM/DD/YYYY
Would you like to add any additional details?

Referrals

When a student enrolls in one of our programs and uses your referral code, you'll receive a $50 one-time credit. Referrals must commit to our program for the full semester before payout. You can track referrals via your student account.
Your Unique Referral Code
How did you hear about us?

Other
Do you have a referral code from a friend or family member? Enter it here so they may receive credit the referral.

Parent/Guardian Information
Full Name

First NameLast Name
Relationship to Student
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cellphone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer
Work Phone Number (Emergency Use)
Please enter a valid phone number.Format: (000) 000-0000.
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Two Emergency Contacts
Name

First NameLast Name
Relationship To Student
Phone Number
Please ensure accuracyFormat: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
Relationship To Student
Phone Number
Please ensure accuracyFormat: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please inform the office of any other vital information you think they may need to know in the event of an emergency.

Family Investment

Our tuition and tutoring rates apply to the current school year and may be subject to change in future terms. These rates apply unless your family has received a individualized quote from the school on official letterhead. After submission of this form, we will send you an invoice for processing or payment based on your selections. Please refer to the Enrollment Agreement for all terms and conditions.
How would you like to pay your family's tuition investment?
If you have received a quote from us, upload it here.

Cancelof

Parent Agreement
Please read, review, acknowledge, and sign this Enrollment Agreement. All terms and conditions are binding. You will receive a copy via email after signature.
Today’s Date
Type your full legal name
Signature
Students Name

First NameLast Name
Should be Empty:

Learning Pod Registration Form