Mi Casa Registration Form 2016
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Mi Casa Montessori
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5940 Lakeview Drive SW, Calgary, Alberta, T3E 5S8
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REGISTRATION FORM
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Student's Information
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First Name:Last Name:Nickname:
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Date of Birth:Health care #:Gender:
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Prior experience in a Montessori school
Yes:No:
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Language(s) spoken and understood by the child:
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Current Address:
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City:Province:Postal Code:
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Mother's Information
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First Name:Last Name:
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Current Address: (if different fromabove)
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Employer & Address:Postal Code:
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Phone Home:Phone Work:Phone Cell:
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Email Address:
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Father's Information
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First Name:Last Name:
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Current Address: (if different from above)
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Employer & Address:Postal Code:
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Phone Home:Phone Work:Phone Cell:
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Email Address:
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For office use only
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Date of registration
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Starting Date
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Program of admissionMorning (9-11:45)Afternoon (12:45-3:30)
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MondayTuesdayWednesday
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ThursdayFriday
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Mi Casa Montessori
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REGISTRATION FORM
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People Authorized to pick child up from school #1
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First Name:Last Name:
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Relation:Phone Cell:Notes:
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People Authorized to pick child up from school #2
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First Name:Last Name:
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Relation:Phone Cell:Notes:
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People Authorized to pick child up from school #3
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First Name:Last Name:
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Relation:Phone Cell:Notes:
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Emergency Contact Information
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Due to Licensing Regulations we MUST have both a phone number and address. This option will only be used if both parents cannot be reached.
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First Name:Last Name:
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Address:
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City:Province:Postal Code:
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Phone Home:Phone Work:Phone Cell:
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Emergency Contact Information #2
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First Name:Last Name:
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Address:
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City:Province:Postal Code:
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Phone Home:Phone Work:Phone Cell:
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Emergency Contact Information #3
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First Name:Last Name:
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Address:
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City:Province:Postal Code:
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Phone Home:Phone Work:Phone Cell:
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Mi Casa Montessori
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REGISTRATION FORM
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Child's Health Record Information
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First Name:Last Name:
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Date of Birth:Health care #:
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Family Doctor's Name:Doctor's Phone Number:
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Are immunizations up to date:
Sign Yes:Sign No:
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Allergies:Symptom\ReactionMedicationEmergency Action Plan
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Administration of Medicine Policy
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A consent form must be signed prior to any parent requiring medication administered to a child at school.
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If children are not well, they should remain at home. For children with severe allergies and/or asthma, parents must leave accompanied medication,
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an inhaler and/or an Epi pen at school.
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Health Care Policy
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Mi Casa Montessori may provide or allow for the provison of health care, contacting 911 and first aid to a child only with written consent
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of the parents/guardians
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Parent SignatureParent Signature
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Other Medical Concerns
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Has your child been Hospitalized?
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DateDiagnosis
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Does your child have any condition or illness that would affect him/her at school?
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Specify:
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Any other medical concerns we should be aware of:
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Mi Casa Montessori
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REGISTRATION FORM
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Class Registration information
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Please indicate your preference.
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AM (9 to 11h45)PM (12h45 to 3h30)
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Program Fees
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3 Half Days$ 420 / Month
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4 Half Days$ 470 / Month
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5 Half Days$ 520 / Month
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Option only available to children4 Full + 1 Half Days$ 800 / Month
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who are 4 and 1/2 years old by Sept.
5 Full Days$ 850 / Month
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