Enrollment Form 2024-2025 Step 1 of 9 11% St. Paul’s Episcopal Montessori - Enrollment Form (School Year 2024-2025 )Please fill out all required fields. If not applicable type in N/A.Current date (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Student Status:*Current StudentNew StudentBy submitting this form, you acknowledge that your child will be returning to St. Paul’s Episcopal Montessori School for the 2024-2025 Academic Year. If you choose No, this will be considered your notice of not attending the next school year, and your child will lose their spot.*YesNoReason for withdrawal*Which school will student attend in 2024-2025?*Student Name* First Name Middle Name Last Name Preferred Name*Date of birth (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Current age*Child's Gender*Child’s Address* Street Address 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 Race and Ethnicity* Asian Black Indigenous Heritage Native Hawaiian or Other Pacific Islander White Hispanic/Latino Other Race and Ethnicity - please specify*Desired Start Date*2024-2025 Academic YearChoose desired program:*Toddler (18 months old -3 years old)Primary (3 years old - 6 years old)Lower Elementary (1st grade - 3rd grade)Upper Elementary (4th grade - 6th grade)Child’s grade level (if applicable)*How did you first learn about St. Paul's?*Current student at St. Paul'sFormer student of St. Paul'sInternetAdvertisingIs there a family that you would like to credit for referring you to St. Paul's?*Is your child up to date on their vaccinations?*YesNo Parent/Guardian InformationParent/Guardian #1 InformationParent/Guardian #1* First Name Middle Name Last Name Preferred Name*Relationship to Child*Home Address* Same as child's address Street Address City State / Province / Region ZIP / Postal Code Home Phone*Cell Phone*Primary E-mail* Employer*Title*Work Phone*Employer Address* Street Address City State / Province / Region ZIP / Postal Code Marital Status of Child's Parents*MarriedSingleDivorcedWidowedSeparatedParent/Guardian #2 InformationParent/Guardian 2* First Name Middle Name Last Name Preferred NameRelationship to Child*Home Address* Street Address 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 Home PhoneCell Phone*Primary E-mail* Employer*Title*Work PhoneEmployer Address* Street Address City State / Province / Region ZIP / Postal Code Are you a member of St. Paul's Episcopal Church?*YesNoStudent's siblings:NameGradeSchool Has the student ever been dismissed, suspended, or denied readmission to a school for any reason?*YesNoHas the student ever received academic testing or evaluation?*YesNo Health information about the childAny special diet or activity limitations?*YesNoIf yes, please specifyAny hearing or vision problems, or special health needs that the school should know about?*YesNoIf yes, please specifyDoes your child has any chronic or lengthy illnesses?*YesNoPlease list any chronic or lengthy illnesses*Does your child has any allergies?*YesNoPlease list any allergies*Have these allergies been diagnosed by a healthcare professional?*YesNoPlease upload a copy of the child’s emergency allergy plan here. If not available for upload, please provide it to the school office. Drop files here or Emergency contacts and Pick-up authorization We require at least 2 emergency contacts on file Please be sure to provide the school with a copy of a current driver’s license for anyone who is authorized to pick-up. Emergency Contact #1 Name* First Name Last Name Relationship*Home Phone*Cell Phone*E-mail* Address* Street Address City State / Province / Region ZIP / Postal Code Authorized to pick-up?*YesNoEmergency Contact #2 Name* First Name Last Name Relationship*Home Phone*Cell Phone*E-mail* Address* Street Address City State / Province / Region ZIP / Postal Code Authorized to pick-up?*YesNoEmergency Contact #3 Name* First Name Last Name Relationship*Home Phone*Cell Phone*E-mail* Address* Street Address City State / Province / Region ZIP / Postal Code Authorized to pick-up?*YesNoAdd another Emergency contact?*YesNoEmergency Contact #4 Name First Name Last Name RelationshipHome PhoneCell PhoneE-mail Address Street Address City State / Province / Region ZIP / Postal Code Authorized to pick-up?YesNoAdd another Emergency contact?*YesNoEmergency Contact #5 Name First Name Last Name RelationshipHome PhoneCell PhoneE-mail Address Street Address City State / Province / Region ZIP / Postal Code Authorized to pick-up?YesNo CHILD’S DOCTORDoctor Name*Phone*Address*Please check the box beside the statement* In the event my child needs immediate medical attention, I authorize St. Paul’s Episcopal Montessori School to transport my child by EMS to the nearest emergency room unless I indicate a different facility. Name of preferred emergency facility*Please check the box beside the statement* BY SIGNING THIS FORM, I AM AUTHORIZING THE ABOVE EMERGENCY INSTRUCTIONS. Signature*Date* Date Format: MM slash DD slash YYYY Hold Harmless AgreementPlease check the box beside the statement I consent to my child’s participation in the activities on the St. Paul’s Episcopal Montessori School (“St. Paul’s”) and Church property, and acknowledge and understand that my child’s participation in any such activities, as well as my child’s storing of any personal property at St. Paul’s or the Church, may involve the risk of injury, death, property damage or other loss. I further acknowledge that these risks may arise from the actions, inactions or negligence of St. Paul’s or Church employees, contractors, volunteers or others, as well as the condition of the property, facilities, equipment or areas where the events or activities are being conducted. Additionally, in consideration for my child’s use of St. Paul’s and Church property and participation in St. Paul’s activities, I hereby waive, release, discharge, covenant not to sue, and agree to hold harmless from any and all claims or causes of action St. Paul’s and its Board, Church, trustees, officers, directors, employees, contractors, volunteers, and agents (“Releasees”), arising out of my child’s use of school and/or Church property. I hereby forever release, hold harmless and discharge Releasees from all liability in connection with acts or omissions occurring during my child’s participation in St. Paul’s activities, including but not limited to liability stemming from any claims of negligence, gross negligence, property damage or loss, contractual default, or intentional conduct. I have carefully read this release and hold harmless agreement and understand the terms herein. I have signed this waiver and release freely and voluntarily and with full knowledge of its significance and meaning. Student Name*Parent/Guardian Name*Parent/Guardian Signature*Date* Date Format: MM slash DD slash YYYY Tuition AgreementPlease read each paragraph, then check ALL boxes in agreement to the terms outlined.* St. Paul's Episcopal Montessori School requires a one-time $100.00 non-refundable Registration Fee upon initial enrollment to the school. When registering for the start of the school year, a seat deposit is due with this agreement and will be credited to the student’s account for the first month of the school year. The receipt of this deposit and the signed agreement constitutes a contract that the student will attend St. Paul’s for the entire school year. THE SEAT DEPOSIT IS NON-REFUNDABLE. The obligation to pay the agreed tuition is not subject to adjustment for illness, absence, or any other reason. If it becomes necessary to withdraw your child, written notice is required THIRTY (30) DAYS PRIOR TO WITHDRAWAL. Monthly tuition is payable on the first day of each month. A late fee of $35 will be added if payments are not received by the 5th day of the month. Hours for extended care are from 3:15pm-5:15pm. There will be a $10.00 per minute late fee charge for students picked up after 5:30pm. If the undersigned has medical insurance, that policy will be considered the primary insurance provider for medical expenses incurred for accidental illness or injury on the School/Church’s property. St. Paul’s reserves the right to terminate this agreement if the student’s behavior or lack of cooperation is deemed unacceptable or if tuition payments are overdue. If the school exercises its right under this section to terminate the agreement, appropriate tuition rebates will be determined on a case-by-case basis. Please select which payment option you would like to utilize for tuition payments*Pre-pay Full Tuition: Due by September 1st. Receive 2% discount. No refunds will be given on tuition payments if student withdraws during the school year.10-Month Payment Plan: Annual tuition is divided equally across the school year, August through May.12-Month Payment Plan: Annual tuition is divided equally across 12 months, June through May. No refunds will be given on tuition payments if student withdraws during the school year.Student Name*Parent/Guardian Name*Parent/Guardian Signature*Date* Date Format: MM slash DD slash YYYY Consent FormsPhoto Consent: Please indicate below whether you give consent for your child to be photographed on campus for public viewing (including but not limited to website, social media, marketing and promotions, etc).*Yes, I give consent for my child’s photograph to be used for public viewingNo, I want to opt-out of allowing my child’s photograph to be used for public viewingFamily Directory Consent: Please indicate below that you give consent to having your child's contact information published in the school-wide family directory, which would be sent out electronically to all families who have children actively enrolled at St. Paul's Episcopal Montessori School. If you give consent to being included in the directory, you do not need to return this form.*Yes, I give consent for my child’s contact information to be in the school directoryField Trip Consent: My child has permission to participate in St. Paul’s Episcopal Montessori School sponsored field trips.*YesNoStudent Name*Parent/Guardian Name*Parent/Guardian Signature*Date* Date Format: MM slash DD slash YYYY CAPTCHAChild Directory ID
