Additional documents for registration
Please provide the following documentation to the school office:
• Current Georgia Immunization Form 3231
Father's Information (list address only if different from above)
Maternal Grandparents Information
Paternal Grandparents Information
Other Grandparents Information
Emergency and Medical Information
In the event of an emergency and the parents are not available, the following person(s) have my permission to come and take my child home from school:
**Please note these individuals are also added to the approved pick-up list for general pick up from school.
**All students must have at least one emergency contact other than the parents on file.
Additional emergency contacts:
In the event that I cannot be reached, I give consent for medical emergency treatment for my child for which I will be financially responsible. I would like my child to be transported to the hospital listed below instead of Tanner Medical Center in Carrollton, Georgia.
Parent Agreement and Emergency Medical Consent
Oak Grove Montessori School reserves the right of direct access to previous school records and furthe reserves the right to withold records of withdrawing students until all accounts due are paid in full.
Oak Grove Montessori School considers the records of all individual students to be confidential information abailable to a child's parents or guardians upon request. Records will only be released to other schools or agencies upon signed request from a parent or guardian and only after all accounts due are paid in full.
My child will not be allowed to enter or leave the facility without being escorted by the parent(s), person authorized byt he parent(s), or facility personnel.
I understand I must provide age appropriate immunization records to the school or a signed affidavit against such immunizations.
I have read and hereby expressly agree to abide by the rules set forth in the Parent Handbook.
The parent/legal guardian signing this form releases Blackstock Montessori School, Inc., dba Oak Grove Montessori School and all School Personnel from and of any liability for such decisions or actiosn in seeking medical care, and agrees to pay all costs and fees for the medical care or treatment authorized under this Emergency Medical Authorization.
I acknowledge it is my responsibility to keep my child's record current to reflect any significant changes as they occur, e.g. telephone numbers, work lcoation, emergency contacts, child's physician, and child's health status.
I warrant that my child is physically fit and able to participate in school activities. I also consent to any employee agent, or other personnel affiliated with the School to seek medical attention and treatment or other measures deemed necessary or advisable in the discretion or judgement of School's personnel for the above-named student in the event of an accident, sudden illness, or other condition that occurs while the above-named student is in the care of under the supervision of School Personnel.
Name of Parent/legal guardian completing form