CLAY MONTESSORI SCHOOL - 463 E. Main Street      Carmel, Indiana 46032   (317) 580-1850
Fishers Montessori School, Inc.
Clay Montessori School
2019-2020 Enrollment Form
Child’s Name: _________________________           Birth Date: _____/______/____
Home Address:_________________________          Phone No.: __________________
Father’s Name: _________________________          Work Phone: _________________
Mother’s Name: ________________________          Work Phone: _________________
Person to call if Parents cannot be                                 Child’s Physician to be called in an
Reached in an Emergency:                                            Emergency:
Name:_________________________                        Name: ____________________
Relationship: ___________________                        Address: __________________
Address: _______________________                        City: _____________________
City: __________________________                        Phone: ____________________
Phone: _________________________                       Hospital: ___________________
Allergies, Medical Conditions, fears, etc.: _____________________________________
Medical Release
I hereby give my consent to Fishers Montessori Schools, Inc. to administer first aid, authorize necessary emergency treatment at a nearby emergency hospital and/or authorize a medical doctor to examine or treat the above mentioned child while he/she is in attendance at Fishers Montessori Schools, Inc. 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.
X_________________________________              _____________________________
Parent/Guardian                                                            Date
NAME:__________________________        RELATIONSHIP:_____________________
NAME:__________________________        RELATIONSHIP:_____________________
I am interested in forming a carpool:                  Yes:_______   No:_______
Name of other driver:______________________ Phone: ______________________
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 because of injury to my child at school or during any off campus activity.
X__________________________________             _____________________________
Parent/Guardian                                                            Date

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