MONTESSORI SCHOOL OF SUDBURY
STUDENT REGISTRATION FORM
 Please complete the following information.
 Student's Information
 Student Name:                                                                                                                          Male
   Last                                                                             First   Female
 Home Address:                                                                                                                                                        
    Street                                                                         City                                  Postal Code
 Date of Birth:                /                          /                                      Home Phone:       (      )                                                  
     Year             Month                 Day
 Physician:                                                                                                                                                         
   Name                                                                                                       Phone Number
 Health Card Number:                                                                                                                                           
   
 Medical  Conditions:                                               Asthma
                                     Allergies            List:                                                                                    
                                     Other:               List:                                                                                    
                                                                                                                                                          
   
 Parent Information
 (Please indicate)                                  Father                          Guardian
 Name:                                                                                          Employer:                                                
  Last                                  First
 Can we contact    Yes                                              Work Phone Number: (      )                                                       
 you at work?    No                        Home Phone (if different from above: (      )                                                       
  Cell phone Number: (      )                                                       
  E-mail Address: (      )                                                       
   
 Parent Information
 (Please indicate)                                  Mother                          Guardian
 Name:                                                                                          Employer:                                                
  Last                                  First
 Can we contact    Yes                                              Work Phone Number: (      )                                                       
 you at work?    No                       Home Phone (if different from above: (      )                                                       
  Cell phone Number: (      )                                                       
  E-mail Address: (      )                                                       
   
 In Case of Emergency Information - Please supply a contact other than parent / guardian
 Name:                                                                                         Phone Number:(       )                           
  Last                                       First
   
MONTESSORI SCHOOL OF SUDBURY
STUDENT REGISTRATION FORM
   
 Acceptance
   
In consideration of the acceptance of this enrollment by the Montessori School of Sudbury, the Undersigned agrees to pay the annual tuition charges.

I understand that my obligation to pay the charges for the full academic year is unconditional and that no portion of such charge so paid or outstanding will be refunded or canceled not withstanding the subsequent absence, withdrawal or dismissal from the school of the above student.

I understand that in signing this contract I accept the terms stated herein and I accept the School's educational programs and any modification deemed beneficial by the School as well as the rules and regulations of the Montessori School of Sudbury, as stated in the school's policies. I agree that in the event of default in payment of any installment provided for in this contract, the above student may not be allowed to continue classes and that the undersigned will be responsible for all attorney's fees and reasonable costs of collection for any outstanding amounts due under this contract.

It is agreed that enrollment as specified within this contract, may be canceled in writing by the parents or guardians according to the School's tuition policies.

Also, I agree that my child _________________________ may participate in all school activities including athletics, and any school-sponsored trip away from the campus unless the school receives written notice to the contrary.
   
                                                                                                                                                                    
 Signature of Parent / Guardian                                                                          Date
   
Office Use Only

Acceptance Date:   Authorized By:  
Enrollment Year:   Grade Level:  
Discharge Date:   Reason: