Summer School 2021 Ride the Wave toAdobe Montessori School’s Awesome Aloha Hawaiian Adventure June 1 – July 23, 2021 Child's Name* First Last Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*Home Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Child lives with*Both ParentsMotherFatherOther Parental Address (if any) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Other Parental Phone (if any)Mother's Name* First Last Mother's Phone*Mother's Email* Mother's EmployerMother's OccupationFather's Name* First Last Father's PhoneFather's Email* Father's EmployerFather's OccupationPlease list other siblings in the family and their ages:Please list name(s) of any other schools your child has attended:List any characteristics, or helpful information you feel your child’s teacher should know about your child:List any allergies or dietary preferences for your child:*Parent DirectoryPlease make the following information available to all Adobe Montessori parents:Parent Directory Child's Name Mother's Phone Number Father's Phone Number Mother's Email Father's Email Address Marketing ReleaseAdobe Montessori School may use photographs, videos, and/or sound recordings of my child(ren) for the purpose of school programs and advertising (both in print and online).Marketing Release ConsentI acceptI refuse**Please Note: Adobe Montessori School will use photographs of your child for classroom use only.Text AlertsI would like to receive alerts via text message from Adobe Montessori SchoolWho should receive alerts: Mother's Cell Father's Cell NO ALERTS Additional PreferencesTeacher Preference (if any):My child takes a nap dailyYesNoEnrollment OptionsEarly Primary (Ages 2 – 3 ½) 5 days/week - FULL DAY: 8:30am - 3:15pm ($211.25/week) 5 days/week - AM Only: 8:30am - 11:30am ($165.00/week) Primary/Kindergarten (Ages 3-6) 5 days/week - FULL DAY: 8:30am - 3:15pm ($205.00/week) 5 days/week - AM Only: 8:30am - 11:30am ($158.75/week) 5 days/week - PM Only: 12:30pm - 3:15pm ($157.50/week) 3 days/week (MWF) - PM Only: 12:30pm - 3:15pm ($141.25/week) 2 days/week (TTh) - PM Only: 12:30pm - 3:15pm ($126.25/week) My child will attend the following weeks of summer school: Week 1 / June 1 - 4 Week 2 / June 7 - 11 Week 3 / June 14 - 18 Week 4 / June 21 - 25 Week 5 / June 28 – July 2 Week 6 / July 6 – 9 (School Will Be Closed on Monday, July 5th In Observance of Independence Day) My child will attend the following weeks of Montessori on the Move childcare days: Week 7 / July 12 – 16 Week 8 / July 19 – 23 Registration Fee: $50.00 This fee holds your child’s placement in the Summer Session. It is not refundable. Please submit this fee when you return your child’s registration form. Tuition Payment Schedule: Tuition for Weeks 1-4 is due June 1st Tuition for Weeks 5-8 is due July 1st Late Pick-Up Fee: Adobe Montessori School is open from 7:30am - 5:00pm. Beginning at 5:01pm, $1 per minute for each additional minute is billed until the child is picked up. Late Tuition Fee: A $25.00 late fee is billed for payments arriving after the 10th of the month. Changes in Registration: Changes may be made in adding weeks to the summer session only. You may always add to your summer registration. However, Adobe Montessori has made staffing commitments based upon the registrations; therefore, no changes which would decrease your child’s attendance may be accommodated. Refund Policy: No refunds will be given for Summer Session changes or withdrawal. I have read all the Summer Session information, and have reviewed & understand Adobe Montessori School policies, as outlined in the Parent Handbook, at www.adobemontessori.com. Changes in Registration: Changes may be made in adding weeks to the summer session only. You may always add to your summer registration. However, Adobe Montessori has made staffing commitments based upon the registrations; therefore, no changes which would decrease your child’s attendance may be accommodated. Refund Policy: No refunds will be given for Summer Session changes or withdrawal.I agree fully to the terms as outlined and wish to enroll my child in the 2021 Summer Session.*By filling out this form, you agree to use your name as your electronic signature.NameThis field is for validation purposes and should be left unchanged.
