Application for Enrolment Form

Application for Enrolment
Child's Full Legal Name*
Child's Preferred Name*
Child's Date of Birth*

MonthDayYear
Date
Child's Gender*
Gender
Home Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Language(s) Spoken at Home*
Session Preferred: (No extended care available at this time)*

Full DayA.M.
Preferred Starting Date*
MM/YYYY
Names of Siblings and Dates of Birth
Children Not Applying to HHMS
Parent/Guardian Information
Full Legal Name*
Preferred Name*
Relationship to Child*
Home Address: Same as Child Different from Child
Home Address if Different From Child

Street Address

Street Address Line 2

CityProvince

Postal Code
Work Address
Home Phone Number
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.
Business Phone Number
Please enter a valid phone number.
Email Address*
example@example.com
Full Legal Name
Preferred Name
Relationship to Child
Home address
Same as Child
Different from Child
Home Address if Different From Child

Street Address

Street Address Line 2

CityProvince

Postal Code
Work Address
Home Phone Number
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.
Business Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Parent/Guardian Signature*

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Today's Date

MonthDayYear
Date

Emergency Information
Child's Name
In the event of an emergency, please list the order of preference in which parents should be contacted.
Emergency Parent Contact #1
Parent/Guardian's Name*
Primary Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Emergency Parent Contact #2
Parent/Guardian's Name*
Primary Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
In the event of an emergency, if a parent cannot be reached, the following individual(s) may be contacted. Please list in order of preference.
Emergency Contact #1
Full Legal Name
Relationship to Child
Primary Phone Number
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
City/Location
Authorized to Pick Up Child

YesNo
Emergency Contact #2
Full Legal Name
Relationship to Child
Primary Phone Number
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
City/Location
Authorized to Pick Up Child

YesNo
Pick-Up Authorization - The following additional individuals are authorized to pick up my child:
Full Legal Name
Relationship to Child
Primary Phone Number
Please enter a valid phone number.
Full Legal Name
Relationship to Child
Primary Phone Number
Please enter a valid phone number.
In case of illness or accident, and if I cannot be reached by telephone, I hereby authorize a staff member or use of ambulance to have my child taken to Headwaters Health Care Centre (hospital).
Child's Health Card #
Doctor's Name
Doctor's Phone Number
Please enter a valid phone number.
Doctor's Address
Please provide any special medical or additional information about your child that could be helpful in an emergency (e.g., known medical conditions such as asthma, allergies, epilepsy, hemophilia or reaction to any drugs, skin conditions, vision/hearing).
If there are custody arrangements pertaining to legal right of access to your child, please provide a copy of the appropriate legal documentation (e.g., court order).
Name(s) of custodial parent(s)
Name(s) of individuals prohibited from accessing your child
Parent/Guardian Signature*

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Today's Date

MonthDayYear
Date

Health Information
Child's Name
If your child has had any communicable diseases (e.g., chicken pox, measles etc.), please list them here.
Does your child have a medical need that requires additional medical support? If yes, an individualized plan for children with medical needs must be developed between the parent and the school prior to the child's first day of care.

YesNo
Immunization Records - Please provide a copy of your immunization record (e.g., yellow card) to the school. If you do not have an immunization record, please fill in the chart below. If you have chosen not to immunize your child, a Statement of Medical Exemption form or a Statement of Conscious or Religious Belief form (Form 4897-64E (2017/07)) must be completed and provided.
DTaP-IPV-Hib(2 months, 4 months, 6 months, 18 months) Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenzae type b
Pneu-C-13 (2 months, 4 months, 12 months) Pneumococcal Conjugate 13
Rot-5 (2 months, 4 months, 6 months) Rotavirus
Men-C-C (12 months) Meningococcal Conjugate C
MMR (12 months) Measles, Mumps, Rubella
Var (15 months) Varicella
MMRV(4-6 years) Measles, Mumps, Rubella, Varicella
Tdap-IPV (4-6 years) Tetanus, diphtheria, pertussis, Polio
1. Does your child have a life-threatening allergy? (e.g., anaphylactic to peanuts, bee stings) If yes, an individualized plan for an anaphylactic allergy that includes emergency procedures must be developed between the parent and the school prior to the child's start date.*

YesNo
If Yes, please provide details
2. Any non-life-threatening allergies?*

YesNo
If Yes, please provide details
3. Please indicate any additional health information that is relevant to the care of your child.
Parent/Guardian Signature*

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Today's Date

MonthDayYear
Date

Optional Information
Do you consent to sharing your email address with other parents?

YesNo
Please let us know if there are specific areas that you might be interested in volunteering at the school should the opportunity arise.
Please share with us any information about your family that might be of interest to share with the school community including family traditions, interests, hobbies, occupations etc.

Parent Consent Form
Please read the following very carefully to ensure that you fully understand the legalities before you sign.

Enrolment Acknowledgment and Terms Agreement

We, the undersigned, hereby affirm that all information provided in our enrolment submissions is accurate and truthful. We acknowledge that we have thoroughly read, understood, and agree to adhere to the terms and conditions outlined in the Application, including those detailed in the Tuition Fee Schedule, Enrolment Documents, and the current Parent Handbook of Headwater Hills Montessori School (HHMS).

In agreeing to enrol our child at HHMS, we recognize and accept the inherent risks associated with school activities. We understand that despite careful supervision, accidents may occur. We acknowledge that there is always a risk of injury to students and potential damage to personal property during various school activities. By signing this document, we agree to release, indemnify, and hold harmless HHMS, along with its staff and employees, from any liability, claims, damages, or demands arising from any injuries sustained by our child.

We understand and acknowledge that Headwater Hills Montessori School (HHMS) reserves the right to make necessary protocol changes that are deemed essential for maintaining the optimal functioning and safety of the school community. These changes may occur without prior notice and are contingent on evolving circumstances. HHMS commits to providing prompt written notification of any significant protocol changes.

We recognize that HHMS has sole authority to make decisions regarding the acceptance or rejection of any student application. Furthermore, the school reserves the right to request the withdrawal of a student if it is judged necessary for the well-being of the overall school community.
Furthermore, we Parent Names* , the parents/guardians of Student Name*, understand that in the event of an accident or illness occurring to my child while at school or while participating in a school excursion, the school will make every attempt to contact me and/or my spouse. If, however, I, or my spouse cannot be reached I hereby give Headwater Hill Montessori School, its Directors, Officers, Agents or Employees authority to act on my behalf in case of an emergency and to take appropriate steps to have a doctor attend to my child. Should any staff member determine, in his/her sole discretion, that the delay needed to contact the parent/guardian could result in unwarranted risk to the child, the staff member will waive the attempt to contact the parent/guardian and seek immediate treatment. If appropriate, 911 will be contacted. In non-emergency situations, first aid or similar care will be provided.
By signing this agreement, we acknowledge that we have read, understood, and are in agreement with its provisions.
Parent/Guardian Signature*

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Today's Date

MonthDayYear
Date
Parent/Guardian Signature

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Date
Should be Empty:

Application for Enrolment

Parent/Guardian Information

Emergency Information

Health Information

Additional Information

Dietary Arrangements

Photo/Video Consent

Parent Handbook - Policies and Procedures

Optional Information

Parent Consent Form