CMCH Enrollment Packet

Chico Montessori Children's House Enrollment Packet

This form only to be filled out once a tour has been completed and your child has been offered a place at Chico Montessori Children's House.
Child's Name

First NameLast Name
Child's Birthdate

MonthDayYear
Date
Parent/Guardian #1 name

First NameLast Name
Parent/Guardian #1 email
example@example.com
Parent/Guardian #1 primary phone
Please enter a valid phone number.Format: (000) 000-0000.
Optional: enter a second phone number for #1 and label it
Parent/Guardian #1 (and child's primary residence) address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2 name

First NameLast Name
Parent/Guardian #2 email
example@example.com
Parent/Guardian #2 primary phone
Please enter a valid phone number.Format: (000) 000-0000.
Optional: enter a second phone number for #2 and label it
Parent/Guardian #2 address if different from parent #1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contacts & Authorized Pick-Up People

PARENTS CANNOT BE LISTED AS EMERGENCY CONTACTS. Emergency contacts must live no more than 30 minutes away and be over the age of 18. Please list the name of at least one (two if there is only one parent/guardian) LOCAL person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in picking your child up and contacting you.
Emergency Contact #1 name

First NameLast Name
Emergency Contact #1 primary phone
Please enter a valid phone number.Format: (000) 000-0000.
Optional: enter a second phone number for contact #1 and label it
Relationship to child/family
This can be a friend or neighbor
Emergency Contact #2 name

First NameLast Name
Emergency Contact #2 primary phone
Please enter a valid phone number.Format: (000) 000-0000.
Optional: enter a second phone number for contact #2 and label it
Relationship to child/family
This can be a friend or neighbor
If you would like to add any additional people who have permission to pick up your child or any other pick up notes, please list them here:

Medical/Health Information

Please note: A separate form must be filled out and returned to us from the child's physician. All State of California required forms are linked at the end of this form.
Child's pediatrician's name

First NameLast Name
Facility/Group name (if applicable)
Pediatrician's phone number
Please enter a valid phone number.Format: (000) 000-0000.
Does your child have any food, medication, or environmental allergies?
If "yes" please list any allergies
Does your child's allergy(ies) require a staff member to monitor for symptoms, take action if a reaction occurs, or give emergency medication to your child?
If "yes" please give details
Please note that any medication to be given on site must have a doctor's note/prescription attached and will be kept in the office.
Does your child have any dietary restrictions, including those for medical, religious, or cultural reasons?
If "yes" please give details

Child's Developmental Information
Age child first walked
Age child started speaking intelligible words
Age child started toilet training (or say, "in progress")
Does your child mostly sleep through the night?
Does your child nap? If so, will you need them to have a nap at school? Naps at school are for full day children only.
Are your child's bowel movement regular? If so, what is the approximate time of daily movement?
How does your child get along/interact with others (family members, friends, etc)? Please give details.
Has your child has any group play experiences? Please give details.
Does your child have any particular fears or needs? Do they have a comfort item? Please give details.

Photo Release
We often have pictures taken at school and on field trips. We do our best to use photos that do not show children's faces (or we blur them) on our social media pages. Please check the appropriate box(es) below to give Chico Montessori Children's House permission to use photos on different platforms, or to opt out.
Child's Name

First NameLast Name
Parent/Guardian Signature

Permission to Share Contact Information
We pass out a class roster to each family, for use when planning play-dates, carpooling, birthday parties, etc. We would like to have your permission to share your info with the other families in your child's class(es). Your information will only be shared with the families in your child's class(es).
Child's Name

First NameLast Name
Parent/Guardian Signature

Field Trip Permission
I give permission for my child to go on walking field trips with our school in the nearby area. We have extra parent volunteers on these field trips and you will be given the opportunity to sign up to be a volunteer before the event.
Child's Name

First NameLast Name
Parent/Guardian Signature

Parent Handbook Acknowledgment
Click to read Chico Montessori Children's House PARENT HANDBOOK

I have read and understand the contents of the Parent Handbook. I agree to fully comply with the policies and procedures of Chico Montessori Children's House.
Signature

30 Day Notice Policy
Chico Montessori Children's House has provided a quality preschool and kindergarten experience for children for many years. We strive to provide your children with the best educational materials and the most qualified teachers available. Your children's learning experience and welfare is our primary concern.

In order to continue this premium educational environment for your child, we must have in place a policy that insures our income is consistent throughout the year. Your tuition provides the materials for the classroom (many of which are consumables for artwork), daily snacks, janitor service, utilities, and building/ground maintenance. We have wonderful educational materials throughout our classrooms that we have accumulated over the years, but it is the on-going monthly expenses that need constant replacing throughout the school year.

The 30-Day Notice Policy is designed to insure that our income stream is not interrupted during the period when a child is withdrawn and a new child begins. It
takes time to fill the spot and very often the new child beginning also has a 30-day notice to give at another school since most private schools also have this policy.
An example on how the policy works: If you are withdrawing your child on January 1st, we need to know on December 1st. This gives us a month to fill the spot. If you tell us on December 15th that your child is withdrawing January 1st, according to this policy, you will be expected to pay January tuition from the 1st to the 15th of January. This is how it works for any given month. There are no exceptions to this policy and there are no refunds.

Amounts not paid are subject to collection.

I have read and understand the 30-day notice policy.
I agree to give 30 days notice before withdrawing my child. If I give less than 30 days notice, I agree to pay the pro-rated amount to complete the 30 days.
Signature

Consent for Emergency Medical Treatment
As the parent/guardian, I hearby give consent to Chico Montessori Children's House to obtain emergency medical or dental care for my child. In the event myself, my family member, or my child becomes sick and/or injured and a parent/guardian cannot be reached, I hereby give permission to secure emergency treatment for my child. I consent to whatever x-ray, examination, anesthetic, medical, surgical, or dental treatment and hospital care are considered necessary in the best judgement of the attending physician, surgeon, or dentist and performed by or under the supervision of the medical staff of the hospital or facility providing medical or dental services. If is further understood that I will assume full responsibility for any such action, including payment of costs.
Child's Name

First NameLast Name
Parent/Guardian Signature

Release of Liability Waiver
I agree to hold harmless Chico Montessori Children's House (CMCH) and it's directors, owners, employees, volunteers, and contractors from any and all claims. I agree to assume the full risk of any injuries, including damages or loss, which I, or my minor child, may sustain as a result of participating in any or all activities at CMCH. This release is intended to release and discharge in advance CMCH (it's directors, owners, employees, volunteers, and contractors) from any and all liability arising out of, or connected in any way with my, or my minor child's, participation in activities at the school.
Child's Name

First NameLast Name
Parent/Guardian Signature

State of California Parent Document Links

To print and fill out in advance. Copies of these documents are also available to pick up in the office.
Physician's Form Link - to be completed by the child's pediatrician before the first day of attendance.

Immunizations Required for Pre-K/Child Care

Medication Consent Form - to be completed by parent/guardian before the first day of attendance - if needed.

Nebulizer Care Consent Form - to be completed by parent/guardian before the first day of attendance - if needed.

Personal Rights - to be completed by parent/guardian before the first day of attendance

Parent's Rights - to be completed by parent/guardian before the first day of attendance

Background Check Information for Parents

All of these forms are available in the office to sign if needed.
Should be Empty:

Chico Montessori Children's House Enrollment Packet

Emergency Contacts & Authorized Pick-Up People

Medical/Health Information

Please note that any medication to be given on site must have a doctor's note/prescription attached and will be kept in the office.

Child's Developmental Information

Photo Release

Permission to Share Contact Information

Field Trip Permission

Parent Handbook Acknowledgment

30 Day Notice Policy

Consent for Emergency Medical Treatment

Release of Liability Waiver

State of California Parent Document Links