Request edit access
Johnson County Montessori School
Johnson County Montessori School (JCMS) was established in 1965 to encourage young children’s natural love for learning and developing problem-solving skills they will use in the classroom and everyday life. Our Montessori-trained and certified teachers provide individualized lessons using proven teaching methods. We offer an inclusion program for children with special needs through our shared campus with the North Star Academy.
Sign in to Google to save your progress. Learn more
Child's First Name *
Child's Last Name *
Child's Gender *
Child's Date of Birth *
Parent 1 Name, Address, Phone Number, Email Address *
Parent 2 Name, Address, Phone Number, Email Address *
Child's Primary Address, Phone Number *
Child's Physician, Address, Phone Number *
Child's Dentist, Address, Phone Number *
Two People to Contact in Emergency/Illness Situation (other than parent/legal guardian). Please include phone number for each contact. *
Are the emergency contacts listed allowed to pick up your child? *
Name(s) & age(s) of sibling(s) *
Does your child have any physician diagnosed medical conditions? *
Does your child have any diagnosed allergies? *
If yes, please specify.
Does your child have any diagnosed intellectual and/or developmental disabilities? *
If yes, please specify.
Does your child have any prescribed dietary restrictions? *
If yes, please specify
Select a program option for your child: *
How did you find out about JCMS? *
STATEMENT OF UNDERSTANDING*I certify that the information I provided on and in connection with this form is true, accurate, and complete. I also understand that if I make any false statement or deliberate omissions on and in connection with this form, GoodLife/JCMS reserves the right to refuse to serve the applicant, terminate the application process, remove the applicant from the waiting list, and/or terminate services.I have read and understand this statement. *
STATEMENT OF UNDERSTANDING: I understand that a nonrefundable $75 registration fee must accompany this registration before my child will be considered enrolled. When my child is ill, I understand that she/he may not be accepted into care. I also understand that the GoodLife's Johnson County Montessori School, Day Care and/or its employees will not be held responsible if items my child brings onto the premises are lost, stolen, or damaged. I agree to read and comply with other policies of GoodLife's Johnson County Montessori School, Day Care that may be communicated to me via parent bulletins, letters, handbooks, or by other means. I hereby give GoodLife permission to utilize photographic images of my child in a responsible and professional manner in advertising or promotional materials, for fund-raising or developmental purposes, and for general public information purposes. Specifically, I give my permission for photographic/videotape/digital images to be utilized in the GoodLife or JCMS website and/or other selected publications or promotional materials.     *
Clear form
Never submit passwords through Google Forms.
This form was created inside of GoodLife Innovations. Report Abuse