Summer Camp Application Form
www.bgmontessori.com Beech Grove, IN. 46107
____________________________________________________________________________________
Name of
Student:__________________________________________ Application
Date:______________
Date of Birth:______________________
Sex:______ Age upon Registering ______ years_____ months
Home Address:____________________________________
Zip________ Phone __________________
Parent/Guardian Information:
Name:
__________________________________Relationship to
student__________________________
Occupation______________________________Employer_____________________________________
Business
Address__________________________Phone_____________Cell_______________________
Name:
__________________________________Relationship to
student__________________________
Occupation______________________________Employer_____________________________________
Business
Address__________________________Phone_____________Cell_______________________
Person Responsible for Tuition
Payments___________________________________________________
Address (If not stated above)
__________________________Zip________ Phone__________________
Last school child
attended__________________________________Phone________________________
Names and Ages of
Siblings_____________________________________________________________
How did you hear about us?
____internet ___phone directory
___brochure
____friend
(name)_____________________________________________
Emergency
contact______________________Phone______________Relationship_________________
Emergency
contact______________________Phone______________Relationship_________________
Child's
Physician____________________________________Phone_____________________________
Do we have permission to contact your doctor in an
emergency? Y N Preferred Hospital____________
Allergies and/or health
alerts_____________________________________________________________
What services would you
like? Check
all that apply:
___Summer I ___Summer II ___Early Drop ___After Care
Grade Entering: _____Toddler (Ages 1-3) Full Day ______Toddler (Ages 1-3))Half-Day
___Preschool
___K ___1st ___2nd ___3rd
___4th
*Return Completed form (both sides)
with $30 Registration Fee OR $50 Registration Fee if both sessions
will be attended. Spaces are limited
and will be given on 1st come 1st served basis.
I give permission for my child
________________________________to attend school field trips (You will receive
prior notification).
Signature_____________________________________
_____________________________________________________________________
I give permission for my child
to have photos taken by teachers for promotional purposes. NO child's name will ever be used for
advertisement purposes. Most
pictures are used for in class work and newsletters.
Signature______________________________________
_____________________________________________________________________
Please Print
Child's
Name _________________________________________________________
Parent
Offering Permission _____________________________________________
Date
Signed __________________________________________________________