Thumbprint Montessori Children’s House College Preparatory Montessori Learning Community 9390 N. Florida Avenue Tampa, Florida 33612 Richardsonmontessori.org Ph: 813.930.2988 Fax: 813.930.2929 Anticipated grade level for 2014-2015 3 Year-Old ___ VPK____ Application is not complete unless the following items are brought in with this form: ___Updated Immunization and health records ___Birth certificate Student Information First Name Middle Name Last Name Address City, State Zip Code Male____ Female____ Age: _____ D.O.B. : ___/___/20___ Race/Ethnicity Survey (Answer Y for Yes or N for No) Hispanic____ American Indian____ Asian____ Black____ Islander____ White____ Emergency Contact Information/Health Information It is imperative that this information be kept up-to-date and correct during the school year. This is important for school information and for your child’s safety at our school. Please provide name, address and phone number for each of the following: This information is important. Please fill out updated address and phone information. 1. Name of Parent/Guardian: _____________________________ Phone:____________ Address:________________________________________ 2. Name of Parent/Guardian: _____________________________ Phone:___________Address:__________________________________________ 3. Referred by: Name:_____________________________ Phone:_____________ Address:_______________________________________________ Name of Primary Care Physician:_________________________ Phone____________ Medical problems currently being addressed:__________________________________ Medications child is currently taking:_________________________ Child’s Drug Allergies:____________________________________ Child’s Food Allergies:___________________________________ Child on Special Diet: Yes___ No____ (NOTE) All allergies must be documented. Emergency Contact Data (This information is important and needs to be updated at all times.) Name_____________________________________________ Phone________________ Name_____________________________________________ Phone________________ Name_____________________________________________ Phone________________ Name_____________________________________________ Phone________________ In case of accident or serious illness, the school will contact the parent/guardian. If the school is unable to contact the parent/guardian or person(s) designated above, the school will contact the physician or will make the necessary arrangements for immediate transportation and treatment. Payment of fees will be assumed by the parent/guardian. I have reviewed and understand the conditions of this document and I understand that if I desire to have my child released to persons other than those listed above, I must provide a list of those persons in writing, with addresses and telephone numbers, to the principal of the school. Important Note: Our facilities are NOT equipped with the necessary accommodations for your child who is not potty trained. We will not accept any children who cannot go to the bathroom on their own. If you do enroll your child and going to the potty is or becomes a hindrance, we will exercise the right to remove your child until they can do this on its own. Breakfast/Snack/Lunch/Dinner Schedule N/A Parent Parent Parent N/A N/A Breakfast A.M Snack Noon Meal P.M. Snack Dinner Snack Evening X_________________________________________ __________ Signature of Parent/Court-Appointed Guardian Date The Richardson Montessori Academy College Preparatory Montessori Learning Community 9390 N. Florida Avenue Tampa, Florida 33604 Richardsonmontessori.org Ph: 813.930.2988 Fax: 813.930.2929 School Material List Grades 1-6 8 composition books (replenished as needed) 3 well-sharpened pencils, daily (only 3 – do not send your child with a hand-held sharpener!) 1 bar eraser 1 soft, cloth or net, pencil pouch (NO HARD PENCIL BOXES) 1 box of 12- or 24- count color pencils 1-2: note binder 1. Children’s Student’s Dictionary 2. Student Thesaurus These two items are an investment in your child’s education!!!! Taken care of properly, they will last well into adulthood. 3. Children’s Atlas (The Montessori child begins immediately to study about the World.) Small pkg. of sheet protectors Plastic storage container – Please no larger than 15 or 16 quarts. All large, crate type containers will be returned to you! NO BOOK BAGS! 1-cloth napkin, daily, every day, with proper eating utensil (if needed)! And lastly, a huge does of discipline, obedience to adults and common courtesy taught at home! 9390 N. Florida Avenue Tampa, Florida 33604 The Richardson Montessori Academy Richardsonmontessori.org Ph: 813.930.2988 Fax: 813.930.2929 College Preparatory Montessori Learning Community School, Student and Family Contract This contract contains Montessori philosophy, the charter law and embodies those ideals that are chosen for our specific school. First, the contract is designed to ensure a safe, secure and healthy learning environment for all students and personnel at The Richardson Montessori Academy. Although very specific guidelines are listed below, no written contract can replace respect, trust, and reasonable judgment of people who want to do the RIGHT THING. As a preparatory Montessori school, The Richardson Montessori Academy is to provide an environment conducive to scholarship. The school and parents’ goal must be one and the same, academics, and all agree to work together towards that end. • • • Dishonest behavior (cheating on classwork, tests, etc.) will lead to disciplinary action including possible dismissal Scholarship extends will beyond the classroom and all homework assigned must be turned in Excessive absences/tardiness area disruption to the educational process and undermines the student’s opportunity to learn and grow. • • • • • • • Student should wear the school uniform I will not put over-the-counter medication to be dispensed by the child, in our child’s possession. Cleanliness is critical to maintaining a healthy and safe learning environment. Our child is responsible for cleaning up after themselves at school Our child will not display any fashion that will be a distraction from the mission: body piercing, tattoos, extreme hairstyles (mohawks, engravings cut into hair) or other inappropriate fashions that might spread throughout the school We will respect community areas, school property, and the property of others. We understand that it is a requirement for the Richardson Montessori Academy to tutor students. Parents are required to provide a way for their children to participate. Parents (or someone in their stead) must give 30 hours of yearly volunteer service that will benefit the school and encourage learning in their children and others. Not volunteering in some form warrants dismissal from the school. In return, The Richardson Montessori Academy Agrees to: • • • • • • • • Be non-sectarian and non-discriminatory in our programs and admission policies Be accountable to the State of Florida Department of Education for our performance Not charge tuition Health, safety and welfare for all students Continuous improvement planning and evaluations Tutorial sessions I/We have read and agree to abide by the rules and regulations of TRMA School Board as stated in the contract. I agree that my child’s photograph may become part of the pamphlets, brochures, newspapers, etc. unless the Head of School receives written notice of the contrary. _______________________ Father/Male Guardian _____________ Date _______________________ Mother/Female Guardian _____________ Date Contract to be signed with application in hand. without Parent-Student Contract. No application is complete