CMS Summer Registration Form

CMS Summer Camp Registration Form

Fill out the form carefully for registration. If you have any questions, please email us at info@claymontessorischool.com
General Information
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent 1 Name*

First NameLast Name
Parent 1 E-mail*
Parent 1 Phone Number*

Area CodePhone Number
Parent 2 Name

First NameLast Name
Parent 2 E-mail
example@example.com
Parent 2 Phone Number

Area CodePhone Number
Phone Number

Area CodePhone Number
Emergency Contact (if parents cannot be reached)*

First NameLast Name
Relation to Child*
Emergency Contact Phone Number*

Area CodePhone Number
Child's Physician*

First NameLast Name
Physician Phone Number*

Area CodePhone Number
More About Your Child
Any allergies or dietary restrictions:*
Any medical conditions or fears:*
Additional Comments:
Medical Release
I hereby give my consent to Clay Montessori School to administer first aid, authorize necessary emergency treatment at a nearby hospital and/or authorize a medical doctor to examine or treat the above named child while he/she is in attendance at Clay Montessori School and on school related off campus activities. I further agree to accept the financial responsibilities for any costs incurred in the treatment of any illness, accident or injury of the above named child. I understand that Clay Montessori School cannot be held responsible for any injury or illness my child may incure.
Parent 1 Signature:*

Clear
Parent 2 Signature:

Clear
Date*

MonthDayYear
Date
Pickup & Carpool
Person (other than parents) authorized to take child from school:*

First NameLast Name
Relation to Child*
Person 2 (other than parents) authorized to take child from school:*

First NameLast Name
Relation to Child*
I am interested in forming a carpool.*
If yes, name of other driver forming the carpool:

First NameLast Name
Participation Release
I give my permission for my child to take part in all school activities including sports and school sponsored trips away from the school premises and release the school from any and all liability to me or my child during any activity.
Parent 1 Signature:*

Clear
Parent 2 Signature:

Clear
Date*

MonthDayYear
Date
Photography Release
The signed party(s) allow Clay Montessori School and Katerina Marie Photography. Art. Designs. LLC the right to share photos in digital and print marketing materials and on social media platforms.

Please note that a child's full name is never posted next to an image of them to ensure their safety.
My Preferences:*

I would prefer my child's face be blurred in any images shared on social media. I understand that this means I will not receive the images of them with their friends without the blurring.I am fine with my child's face being shown in images used on social media. I look forward to seeing pictures of them with their friends!
Parent 1 Signature:*

Clear
Parent 2 Signature:

Clear
Date*

MonthDayYear
Date
Enrollment Agreement
Drop Off: 9:00am
Pickup: 11:45am

Children ages 3-6 only
I/We am registering my/our child for: (select all that apply)*

Week 1 (July 13-16)Week 2 (July 20-23)
1. The tuition rate of $175 per child is per week and due at signing and is non-refundable.
2. There is no reduction in cost when a child is absent from school due to illness, vacations, early withdrawl or for any other reason. There are no prorated options for summer camp if not all 4 days in the week selected can be attended by the child. Weeks booked cannot be transfered to other families.
3. The parent(s) or guardian(s) signing understand that the weekly fee is non-refundable as it is used to reserve one of the limited spots for the child. The parent(s) or guardian(s) signing understand that the payment for the week(s) selected must be paid in full at the time of signing.

Clay Montessori School has the right to terminate this enrollment agreement without refunds given. This includes and not limited to enrollment fee and tuition.

I acknowledge that I have read this agreement and hereby agree to the foregoing provisions.

Please sign and date this Agreement:
Parent 1 Signature:*

Clear
Parent 2 Signature:

Clear
Date*

MonthDayYear
Date
Before submitting, please make sure all information has been accurately filled out. If the household has two parents, both must complete and sign the form.
Should be Empty:

CMS Summer Camp Registration Form

General Information

More About Your Child

Medical Release

Pickup & Carpool

Participation Release

Photography Release

Enrollment Agreement