Child's Information

Child's first name *

Child's last name *

Child's Birthdate *

Child's Gender *

Grade in Fall *

Parent Information

Parent/Guardian 1:

First Name *

Last Name *

Phone *

Email *

Address *

City *

State *

Postal code *

Parent/Guardian 2:

First Name

Last name

Phone

Address (if different from above)

City

State

Postal Code

Additional Information

Emergency contact *

Emergency Contact Phone Number *

Allergies and Action Plan:

Authorized Pick-up 1: *

Authorized Pick Up Phone Number 1 *

Authorized Pick-up 2:

Authorized Pick Up Phone Number 2

Authorized Pick-up 3:

Authorized Pick Up Phone Number 3

Please fill out one form for each child enrolling for the summer program.

Morning Children's House Montessori Ages 3 to 6

Children's House Lunch - Monday to Friday, 11:45 a.m. to 1:00 p.m.

Morning Elementary Explorers - Grades 1 to 5 Monday to Friday, 8:15 a.m. to 11:45 a.m.

Elementary Explorers Lunch - Monday to Friday, 11:45 a.m. to 1:00 p.m.

Total: *

Yes

Cancellations and program changes must be submitted at least 14 days prior to the program start date and are subject to a $25 administration fee. There will be no refunds for programs canceled with less than 14-days’ notice. The cancellation policy is not dependent on the status of summer program waitlists.
Please contact Sarah with any questions: [email protected]