student information, health and permission form

A.student information
A.student name *
A.student name
A.student home address
A.student home address
A.student date of birth
A.student date of birth
B.parent information
B.parent 1 name
B.parent 1 name
B.parent 1 address
B.parent 1 address
B.parent 1 home phone
B.parent 1 home phone
B.parent 1 work phone
B.parent 1 work phone
B.parent 1 cell phone
B.parent 1 cell phone
B.parent 2 name
B.parent 2 name
B.parent 2 home address
B.parent 2 home address
B.parent 2 home phone
B.parent 2 home phone
B.parent 2 work phone
B.parent 2 work phone
B.parent 2 cell phone
B.parent 2 cell phone
emergency & early dismissal contact information
in case of emergency or early dismissal, please list contacts other than parents that should be notified
contact 1 name
contact 1 name
contact 1 home phone
contact 1 home phone
contact 1 work phone
contact 1 work phone
contact 1 cell phone
contact 1 cell phone
contact 2 name
contact 2 name
contact 2 home phone
contact 2 home phone
contact 2 work phone
contact 2 work phone
contact 2 cell phone
contact 2 cell phone
medical information
child's doctor
child's doctor
doctor phone
doctor phone
please list any medications your child is taking
does your child have allergies
if yes, please list your child's allergies below
please list all allergies for your child
child's dentist
child's dentist
dentist phone
dentist phone
release information
list persons other than parent to whom child may be released. Please send in a note with your child letting us know who will be picking up your child. They will be asked to present photo ID before the child will be released to them.
name 1
name 1
name 1 home address
name 1 home address
name 1 work phone
name 1 work phone
name 1 home phone
name 1 home phone
name 1 cell phone
name 1 cell phone
name 2
name 2
name 2 home address
name 2 home address
name 2 work phone
name 2 work phone
name 2 home phone
name 2 home phone
name 2 cell phone
name 2 cell phone
other permissions
field trips
Parents will be notified of school field trip details in advance. If distance permits, students may walk as a group. It is understood that all reasonable caution will be taken by those persons in charge to prevent injuries, but neither those persons in charge nor the school shall be held legally responsible in case of an accident. I permit my child to participate in all student related activities, including school supervised field trips, while enrolled at MRM and give permission for appropriate faculty member(s) to authorize any emergency treatment that may be necessary.
press releases and photo permission
Throughout the year, MRM produces a variety of publications about the school featuring our students. I permit photographs of my child to appear in both internal and/or external advertising and promotional materials related to MRM and that news of my child’s special accomplishments may be sent to the media.
school directory
I permit my information (phone, address & email) to be published in the school directory.
transportation
I permit my son/daughter to ride in the cars of:
MRM staff
parents of MRM students
chartered buses
EMERGENCY CARE
In case of an illness or accident: I give Many Rivers Montessori and its staff permission to provide any emergency care for my child that it deems necessary, including but without limitation to, calling a doctor for medical or surgical care, or to have my child taken to a hospital by ambulance. I understand that a conscientious effort will be made to locate me (and/or my partner) before any action will be taken. If it is not possible to locate us, this expense will be accepted by us. I agree to hold the program and its staff harmless from any liability resulting from any action or omission made in good faith resulting from said medical care. Indemnification: In consideration of the acceptance of my child as a student in this program, and having satisfied myself that supervision and attention to safety are prudent and reasonable, I agree to indemnify and hold harmless Many Rivers Montessori and its staff against all claims and demands made by or on behalf of my child, including through or by me, my spouse, or the legal guardian of the child.