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Children's House Montessori School

Enrollment Packet

Step 1 of 4

25%

Enrollment Packet
Personal History
Name of child
First Name Last Name
Date of birth
Date Format: MM slash DD slash YYYY
Sex
Social Security #
Address
Street Address City State / Province / Region ZIP / Postal Code
Telephone #
Who should we contact in an emergency (other than parents)?
- Yes
- No
Name
Relationship to child
Address
Business telephone
Home telephone
Cell telephone
Other children in family - names and ages
Other members of household
Are both parents living in the household?
- Yes
- No
Is either parent deceased?
- Yes
- No
Is either parent away from home for long periods of  time?
- Yes
- No
How does your child relate to other family members?
Please describe any alienations/frictions in the family you think we should be aware of:
Describe any fears or anxieties your child may have/has had in the past. If possible, relate these to any significant events in his life, e.g. new baby, moving house, divorce, deaths, accidents or hospitalizations:
List other schools attended -- please give names and dates attended:
Describe briefly your child's adjustment to school, Sunday School, camp or any other group activities, separate from family events. Include how he/she reacts to counselors, teachers, peers and their parents:
Does your child have a room alone at home?
- Yes
- No
If not, with whom does he share?

Daily Routine
What time does your child get up?
Go to bed?
Does he sleep well during the day?
Does he sleep well at night?
Does he have a place to play outdoors?
Does he have any food dislikes?
Allergies?*
Does your child have any special needs or limitations?
- Glasses
- Hearing-aid
- Orthopedic shoes/braces
- Medication
- Observation for seizures
- Motor difficulties
- Language problem
- Learning disability
Were there any significant events of pregnancy or delivery?

Personal History
Was your child adopted after age 6 weeks?
- Yes
- No
If so, at what age?
Are there any significant features of adoption that the school might need to be aware of i.e. emotional/medical?
When your child was very young, were you ever concerned about motor or language development?
- Yes
- No
If so, please explain the area of concern (e.g. walked/talked late,  wore braces for orthopedic reasons)
Is your child right handed?
- Yes
- No
- don't know yet
Is your child left handed?
- Yes
- No
- don't know yet
Is your child ambidextrous?
- Yes
- No
- don't know yet
Did he/she ever switch hands after 2 1/2 years?
- Yes
- No
Person(s) financially responsible for this child:
Name
Telephone
Address
Who has custody of this child?
Name
Telephone
Address
Are there any legal facts regarding a divorce, separation, custody, adoption etc. that the school should be made aware of?
**THIS INFORMATION WILL BE AVAILABLE TO TEACHERS AND CHILD CARE STAFF**
Please list persons other than custodial parent(s) who have permission to pick up your child from school:
Is there anyone who may NOT pick up your child from school?
For care when child is ill
Parent's name
Business telephone
Home telephone
Cell phone
Work hours
Parent's name
Business telephone
Home telephone
Cell phone
Work hours
Physician
Phone
Address
Street Address City State / Province / Region ZIP / Postal Code
Information given by
Signature
Date
Date Format: MM slash DD slash YYYY

Discipline Policy
Montessori discipline is an inner discipline — control which the child develops over his own behavior, through his interest in the Montessori materials, positive social orientation, and in caring for both the learning environment and other individuals. The Children's House. Montessori School offers an educational program with freedom of movement for children, and freedom within limits for work choices. Some children are more successful in an environment with a more direct instructional method of teaching. Parents of children who experience impulsive or aggressive behavior may be advised to seek a school that specializes in direct instruction.

If the ground rules are consistently followed and positively reinforced, the necessity of external discipline will be diminished. When such external discipline is deemed necessary, the following guidelines will be observed:
- Rules are stated on the child's first day of school. Daily reminders are given, if necessary, to the group as a whole.
- Inappropriate behavior is stopped by the teacher or assistant/aide.
- If possible, work/activity is offered as preferable to isolation if the child appears to be 'in control'. However, if the child needs to regain control, he is isolated from work/classroom activities for a short time to re-think his/her behavior; the child is then asked if he/she is ready to return to the class.
Problem-solving skills are reinforced as well as suggestions for alternative behavior choices.
- Continued misbehavior may mean the child is isolated from the group with adult supervision.
- Parent will be called to discuss the child's continued behavior.
- Parent will be called to take the child home immediately. A conference will follow If the inappropriate, unwanted behavior persists, suggestions will be made that an alternative school may better meet the needs of the child in question.
Policy regarding biting: Biting is normal behavior for some toddlers. Toddler bites are not intentional. Our staff supervises closely at all times. Everything possible is done to keep all the children at our school safe and secure.

Just as falls and other minor mishaps cannot always be prevented, neither can all bites. Injury reports are completed on all bites that leave a mark.. The parents of the children involved are informed of the incident. When older children bite intentionally, the above guidelines are followed. Parents who have further questions about biting are invited to discuss the matter with our Director.

Please sign where indicated, confirming you have read the above Discipline Policy. This signed document will be kept in your child's file.
Parent/guardian signature
Date
Date Format: MM slash DD slash YYYY
Authorization for Emergency Care
Check the box beside the statement:
- In the event of an accident The Children's House Montessori School requires a parent or guardians' authorization for their child to receive immediate medical care and/or transport to the nearest hospital.
- By signing this document I give permission for my child/children to receive immediate medical care and/or transport to the nearest hospital in the event of an accident.
Photo Consent
Select One:*
- I give permission to Children's House Montessori school to use my child's photo on closed Facebook pages and any other Advertising for the School.
- I do not give permission to Children's House Montessori school to use my child's photo on closed Facebook pages and any other Advertising for the School.
Parent/guardian signature
Date
Date Format: MM slash DD slash YYYY
Parents shall be informed

*That children may be subject to interviews by licensing staff, child maltreatment investigators and/or law enforcement officials for the purpose of determining licensing compliance or for investigative purposes. (Child interviews do not require parental notice or consent.)

*All caregivers are mandated reporters under the Child Abuse Law. The caregiver/director shall notify the Child Maltreatment Hot Line Number at 1-800482-5964 when there is a reason to believe that a child has been abused or neglected. (AR Code Annotated 12-12-501 et seq.)

*A written daily schedule available for review by parents and licensing staff, which includes age-appropriate activities.

*Children shall be protected from overexposure to the sun. Sunscreen shall be used if needed and as directed by the parent. Suntan lotions and/or sunscreens used for infant/toddlers and pre-school children shall be kept out of the children's reach and shall be administered only with written parental permission. (Blanket permission may be obtained annually.)
Check the box beside the statement:
- I have read and understand the above Minimum Licensing Requirements.
Parent/guardian signature
Date
Date Format: MM slash DD slash YYYY

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