Seed Afterschool 2019-20
Thank you for your interest in Seed; we look forward to working with you and your child.
This registration document is non-binding, but to assist us with enrollment, please answer all of the required questions marked with a red asterisk. A $150 deposit is required to secure a spot.
Contact us at seedMontessori@gmail.com with any questions.
Our Seed community welcomes you, and wants to learn more about your family.
Email address *
Child's first and middle names *
Child's Nickname, if applicable
If this child is accustomed to being called by another name, please list it here.
Child's LAST name *
Last name ONLY here
Child's birth date *
Your full name *
Please identify yourself as the person filling out the application.
What is your relationship to this child? *
Have you already toured Seed Montessori? *
Parents are required to tour the facility and meet Director Ileana Gómez before regular attendance begins.
Best phone number to contact family as a first resort *
This phone number may be the same as another listed in this application. Please list the phone number, name and relationship. (i.e., 555-555-5555, Jane, mother)
How did you find out about Seed? *
If Seed was recommended to you by another family, please name them here so that we may show our appreciation.
How often do you anticipate using Seed services for this child? *
Four days per week is the minimum for new registrants. You can add services at any time pending availability. (Note: Institute Days are included at no extra cost for all students who attend at least 4 days/week.)
Which specific days will your child regularly attend Seed? *
Required
What do you think your child most loves to do?
Whether it is a school subject, a hobby, or a social interaction, tell me what your child really loves.
What do you see as your child's greatest strength? *
What do you see as your child's greatest challenge? *
If you could impart to your child just one gem of wisdom, what would it be?
Name of child's school 2019-20 *
Name of child's teacher, if known *
Child's Grade in School *
Describe any special services your child receives/will receive from D97. *
Permission to transport your child *
Please type your name and relationship below, authorizing Seed to transport your child from school to Seed, and on local field trips (Example: Jane Doe, mother). Most commonly we ride Seed vans, but on occasion we walk and use public transportation. Seed transports from Oak Park D97 schools to our classroom, and your child's productive afternoon begins the moment she/he enters the van to join peers. We have booster seats and safe, modern vehicles with responsible, mature drivers. Children are sent to their D97 school office at dismissal time, where they wait for the Seed van. On the way back to Seed, we may stop at the park, or run a class errand, so families who need to pick up early inform us in advance to coordinate. The deadline for pickup is 6:15 pm.
Mother's full name *
Mother's cell phone *
Mother's work phone
Mother's email *
Father's full name *
Father's cell phone *
Father's work phone
Father's email *
Child's primary address *
Please list the address of the child's first home
Child's second address
If applicable, please list the child's second address
Does your child carry an Epi-pen? *
For safety, we need to know who carries an Epi-pen. Children who carry Epi-pens are required to have one while in attendance at Seed Montessori
Child's food allergies and dietary restrictions *
Food is an important part of life at Seed. Often it is fruit, or the greens we grow in our own garden. Occasionally a quesadilla, or some rice. Quinoa? And on birthdays, etc., there may be occasions when we have food in the classroom. Please list any and all known food allergies or other restrictions. If there are none, please write "No food allergies/restrictions."
Other Health Issues *
Please list any other health issues you would like to make us aware of. If there are none, please write "none."
Permission for Seed Montessori to call 911 and refer your child for treatment in the case of emergency. *
Safety is our first priority but we must be prepared for anything. In case of emergency, we will call 911, and then notify parents immediately. By checking below, you indicate your permission for Seed Montessori to seek medical attention for your child in case of emergency.
Emergency Contact *
Please list name and phone number we should use if parents cannot be reached in case of emergency.
Second Emergency Contact *
Please list name and number of a second emergency contact.
What is the name of your child's health insurance provider? Policy number? *
Safety is the first priority at Seed. In the unlikely event that an emergency should arise, we keep this information confidential and on file so that we can arrange for prompt response.
Check here to acknowledge Seed Montessori's right to photograph or film for potential educational and promotional purposes. *
Because many images are group shots, it is a condition for Seed program participation that families grant Seed's right to use any photos and videos for promotional purposes. Children's personal information will remain confidential and not appear for publication.
Seed Billing Procedure *
Seed operates on a membership model. A single monthly fee is billed to your credit card automatically on the 15th of each month; there are 10 equal payments, August through May. The monthly fee includes scheduled after-school learning every school day, transportation, and attendance on all four Institute Days from 8 am-6:15 pm. [Institute days are included at no extra charge for all students even if your child does not usually attend that day of the week.] Early dismissal days are included in the price, and treated like any other weekday, and follow your child's schedule. Families who attend less than five days but who need special service can add an extra afterschool day at a cost of $35. The first monthly payment will be charged on August 15, 2019. Parents will submit a signed credit card authorization for this purpose. The $150 deposit is credited to the May-June payment, or forfeited in case of early withdrawal. There are no refunds for days missed. On school holidays, Seed may offer programs at an additional cost if there is enough family demand. Parents can now reserve a spot at Seed for the 2019-20 school year with payment of a $150 deposit per child which will be billed upon acceptance of this 2019-20 registration form. [If families enroll after the school year begins, the deposit and the first payment are charged immediately, and on the 15th thereafter.]
Required
I understand that withdrawal from Seed membership requires written 30 day notice and forfeiture of the deposit. *
Your full name here.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy