1. education
2. school

At Discovery Kidzone Summer camp we plan activities to keep your kids busy
while having fun all summer. Our daily schedule consists of an opening large
group activity, learning and explore stations including: hands on science, art,
outdoor classroom and workshop, cooking and games. After morning rotations we have a field trip or outdoor group activity followed by lunch and
afternoon summer packet learning time.
We understand that summer is about fun and activity but we also know how
important it is for children to practice the skills they have learned in school in
order to retain that knowledge. We plan a special time each day that is
geared towards individual learning, reading, ipad apps and computer games.
We plan field trips weekly, a sample of some of the field trips are: horseback
riding, swimming at memorial pool, art museums, exploration works, fishing
at the creek, clark’s bay, Helena Kidsports, the library, downtown walking
mall, ice cream shop, memorial park , geo caching, strawberry mountain,
bounce house day ect.
We are excited that you chose us to spend your summer with . We have very
limited spots. Please sign up soon!
Rachel and Eric Supalla
June 8th-12th
June 15th-26th
June 29th-July 3rd
July 6th-10th
July 13-24
July 27-August 7th
August 10th-21st
Summer Camp School Age
Ages 5-12
Contract 2015
Preschool Contract 2011-2012
Director, Rachel Supalla
1 Friendship Lane
Montana City, MT 59634
(406) 443-5833
[email protected]
www.kidzonemontessori.com
THIS AGREEMENT is entered into as of this
day of
in Location by and between Supalla Inc, DBA Discovery Kidzone
Montessori School Rachel Supalla (hereinafter referred to as "Provider") and _________________________ (hereinafter referred to as
"Parent/Guardian").
Parent Email address:____________________________________________________________________
This Agreement contains the terms agreed upon between Provider and Parent/Guardian for the care of:
Child ____________________________________________________________ D.O.B. _____________
Child ____________________________________________________________ D.O.B. _____________
1. Monthly Rate: Payment is due and payable the first of every month. If your child is absent from care the normal daily
rate will be due and payable. A 30 day notice is required before the end of contract is ceased, if not received tuition will be
due and payable. We accept drop-in for afterschool care and summer camp.
Daily Rate $27.00 full day 15.00 half day
Weekly Rate $135.00
Best Beginnings Scholarships: We accept best beginnings scholarships but will not begin care until the scholarship has
been completely approved. You are required to pay the additional amount of tuition due that is not covered by your
scholarship.
3.
Sibling Discount: 10% off the 2nd child, 15% off the 3rd child off the lowest rate.
4.
Days and Hours: The parties to this agreement have agreed to the following schedule of care. We are also open on
most school closure days and offer full day care for school age kids including meals.
Please circle the days needed for summer camp: Monday Tuesday Wednesday Thursday Friday
5.
Late Fees: Parent/Guardian agrees to pay a late fee $2.00 a min for the time that Child remains in care after the
hours. If the monthly rate is not paid by the 5th of every month the Parent/Guardian agrees to pay a late fee in the amount of
$10.00 per week until the account is current. The check bouncing fee is $35.00 and any other fees it may incur. All late fees
are due and payable immediately.
6.
Provider Vacation: The parties agree that the school will be closed on the 24 th, 25th of December and the 1st of
January. 2 days Easter Vacation, 2 staff training days and all federal holidays that will incur each year. Dates may be subject
to change.
8.
Tuition Express and Pro Care: In order to insure more quality time with your child we require every parent to be
enrolled in our secure and safe automatic billing system through procare tuition express. Tuition is due the 1 st of every month
however, you may set up an alternative billing schedule if necessary.
9.
Holiday Closings: New Years day, President’s day, Memorial day, Independence day, Labor day, Columbus day,
Thanksgiving and the day after, Christmas Eve and Christmas, the Friday before and Monday after Easter.
10.
Referral Credit: Every currently enrolled student is eligible for a $25.00 referral credit for every new student they
refer. Once the new student has paid for their registration and has completed a month of tuition you will receive a credit.
This is unlimited you can refer as many students as you like.
11.
Open Door Policy: At Discovery Kidzone we have an open door policy. This means at any time during the day
you can come, visit, volunteer or spend time with your child. We value you as a parent and know that parent participation is
great for your child’s growth and development as well as helpful for our program. Please feel free to stop by any time.
12.
Meals Included: All full time students receive all meals at no additional cost. We participate in the CACFP.
CACFP is the Child and Adult Care Food Program, a Federal program that provides healthy meals and snacks to children. A
new income eligibility form is required for each family annually.
13.
Summer Camp: Summer camp registration fee is $25.00; this is due by March 1 st. Summer Camp will begin the
week after school is out and will run until the week before school starts. The daily rate for summer camp is 27.00 a day. We
will have a different camp theme every 2 weeks. Every week we will go to the movies, pool and an additional theme based
field trip. Please Circle the camps you wish to sign up for this summer: Survivor Camp June 8-12,
Drama and Building Camp June 15th-26th, Mad Science and Potions Camp June 29th-July 3rd, Sports Camp July 6th10th, Art Gone Wild July 13th-24th, Outdoor Explorers (Survivor) July 27th-August 7th, Tropical Island Vacation
August 10th-21st
By Parent/Guardian: _________________________________________________________ Date: __________________
State of Montana
Department of Public Health and Human Services
Quality Assurance Division – Licensure Bureau
Child Care Licensing
DPHHS-QAD/CCL-113
(Revision 7-2006)
EMERGENCY CONTACT AND PARENTAL CONSENT
THIS FORM MUST BE TAKEN WITH THE CHILD WHEN EMERGENCY MEDICAL CARE IS NEEDED.
Child’s Name:
Birth Date:
Address:
Mother / Legal Guardian’s Name:
Home Number:
Address:
Cell Number:
Work Address:
Work Number:
Father / Legal Guardian’s Name:
Home Number:
Address:
Cell Number:
Work Address:
Work Number:
Emergency Contact Person:
Contact Number:
Emergency Contact Person:
Contact Number:
Physician / Medical Care Source:
Contact Number:
Health Insurance Carrier & Policy Number:
Persons authorized to pick up child:
Name:
Name:
Name:
Name:
– SEE REVERSE SIDE –
WRITTEN CONSENT IS GIVEN FOR:
□ Yes □ No EMERGENCY MEDICAL CARE
□ ADMINISTRATION OF PRESCRIPTION MEDICATIONS
Medication Authorization form and Medication Administration Log
Must be completed
□
ADMINISTRATION OF NON-PRESCRIPTION MEDICATIONS
□
ADMINISTRATION OF SPECIAL DENTAL OR DIETARY NEEDS:
OTC Medication Authorization Form and Medication Administration
Log must be completed
Please Specify:
□ TRIPS:
□ Yes □
□ Yes □
No TRANSPORTATION BY THE FACILITY FOR TRIPS
No
DAILY TRANSPORTATION PROVIDED BY THE FACILITY (Facility Has the Option to Offer)
IF YOUR CHILD IS TRANSPORTED BY THE FACILITY, ARE THERE ANY INSTRUCTIONS FOR SPECIAL CARE FOR THE CHILD (I.E. MOTION SICKNESS,
SEIZURES, ETC.) DURING TRANSPORTATION?
HEALTH HISTORY
Hay fever, asthma, or wheezing
Eczema or frequent skin rashes
Convulsions/Seizures
Heart condition
Allergies or reaction: (food or other)
YES
NO
□
□
□
□
□
□
□
□
YES
NO
□
□
YES
NO
□
□
Chickenpox
Diabetes
Trouble with passing urine / bowel
movement
Frequent colds, sore throats,
earaches, tonsillitis, pneumonia
YES
NO
□
□
□
□
□
□
□
□
Please Explain:
Other Health Concerns (special
disabilities):
Please Explain:
SIGNATURE OF PARENT OR GUARDIAN
DATE
Child’s Biography
My name/nickname is: ____________________________________________
My parents/guardians names are: ___________________________________
Please list any special skills or ways you would like to help volunteer:
_____________________________________________________________
I have ____ brothers & ____ sisters, their names and ages are:
_______________________________________________________________
My favorite activity is: _____________________________________________
My favorite food is: _______________________________________________
My favorite person is: _____________________________________________
My favorite toy is: ________________________________________________
I am afraid of: ___________________________________________________
I can do all these things by myself: __________________________________
Please list prior caregivers and/or day care centers:
_______________________________________________________________
What type of discipline is used at home? _______________________________________________________________
Does your child have a special diet? _________________________________
Due to your child’s tastes, allergies, reactions, and/or religious beliefs,
are there any foods, which should not be served to your child? ___________
Please list these foods: ____________________________________________
Please list any personal habits, thumb sucking, nail biting, etc.
and/or specific words used to describe bodily functions or objects:
________________________________________________________________
What are your main expectations of this program:
________________________________________________________________
Health and Illness Policy
Parents agree to keep (or take) their child/children at home or seek alternate care arrangements as soon as possible within a 30 min.
time frame your child must stay home from school until 24 hours after being symptom free if they need to be picked up for the following conditions:

Fever (100 °f or higher) – child needs to be fever free for 24 hours without the aid of medication

Diarrhea – child must be symptom free for 24 hours without the aid of medication

Vomiting – child must be symptom free for 24 hours without the aid of medication

Runny nose with colored discharge –check with doctor

Rash – check with doctor

Discharge from eyes or ears

Lice – child needs to be treated and nits removed before return

Communicable Diseases - chicken pox, measles, mumps, conjunctivitis (pink eye), influenza etc. The
child may return when the incubation and contagious period is passed and the child is well enough to
resume normal childcare activities.
Medication:
If your child is on antibiotics he/she continues to be contagious for 24 hours after the first dose of medication and can not return to
childcare until this time period has passed.
child care regulations prohibit me from giving your child medication of any kind.
(please detach and return to preschool)
By signing below, I accept and agree to the health and illness policy at Discovery Kidzone Preschool.
By Parent/Guardian: ____________________ Date: __________________
Photo Release
Provider’s name: Discovery Kidzone Montessori School or Rachel Supalla
Child’s full name: _______________________
Photographs and videos are taken on different occasions such as birthdays, holidays, outings and special
occasions and for educational purposes. We use these pictures/videos in our school for teaching, arts &
crafts, albums and various other things. We upload the pictures to our websites
www.kidzonemontessori.com, www.facebook.com/discoverymontessoriMT. http://www.facebook.com/
DiscoveryMontessoriMT#!/KidzoneTeachermama http://discoverykidzone.blogspot.com/
Please mark the appropriate box:
□ I give permission
□ I do not give permission to Discovery Kidzone Montessori or Rachel Supalla to take photographs/
videos or have photographs/videos taken of the above named child should the occasion arise.
I understand that these photographs and/or videos will not be sold and will be handled with the utmost
care.
By Parent/Guardian: ____________________
Date: __________________
By Rachel Supalla: ____________________ Date: __________________
DPHHS-QAD/CCL-120
(Revision 06-07)
NON-INGESTIBLE
OVER THE COUNTER (OTC) MEDICATION
AUTHORIZATION FORM
TO BE COMPLETED BY PARENT
Child’s Name______________________________________________________Date of Birth_____/____/___
Program Name____________________________________________________Today’s Date_____/____/___
*************************************************************************************************
I give permission for the administration of following non-ingestible over the counter medications (mark all that
apply):

Diaper Rash Cream/Ointments

Insect Repellent

Sunscreen

Cortisone/Anti-Itch Creams/Ointments

Medicated Lip Treatments

OTC Antibiotic Creams/Ointments

Burn Creams/Sprays

Other Non-Ingestible OTC’s: (Please Specify)______________________________________________



____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
To administer a non-ingestible over the counter (OTC) medication:

The OTC medication must be brought to the day care facility from the parent;

The OTC medication must be in its original container, with a legible label, and expiration date of medication;

The child’s name must be on the original container
Special handling/storage Instructions____________________________________________________Refrigeration Y/N
Parent/Guardian Signature (required)__________________________________________________________________
*
This document must be updated on an annual basis.
Unused Medication: Returned to Parent Y/N
or
By: ________________________________________________
Discarded Appropriately
(circle one)
Date _____/_______/_______
*Keep in the child’s file when medication is finished.
Discovery Kidzone Elementary Summer Camp
Field trip, camping and activity permission slip
Participant’s Name:
Parent’s name:
Phone Number and Email:
Has my permission to participate in summer field trips and activities at Discovery Kidzone Montessori school run by Supalla Inc, in Helena, Clancy and Montana City, Montana.
I also give
permission to attend an overnight campout in Eric and Rachel Supalla’s
backyard at 26 sweetgrass rd in Montana City Montana in August 2015
All adult participants must sign this document. A parent or legal guardian must sign if the participant is under 18 years of age.
ACTIVIES, RISKS AND ACKNOWLEDGEMENT AND ASSUMPTION OF RISKS:
Participating in Discovery Kidzone Summer educational, instructional and recreational camps run by Supalla Inc may include unforeseen risks. These activities can
take place inside or outside, they can take place day or night, be located on public, private or community land. May include but not limited to: climbing on natural
rocks or boulders, hiking, kayaking, backyard ziplining, 4-wheeling, boating, camping, survival activities and use of any equipment, first aid skills, sports and games,
transportation in vehicles, swimming and water activities, fishing, I acknowledge that unforeseen risks, hazards and dangers may arise. The parent gives permission for the child to participate in these activities.
Parent Signature:
Date:
Program Director Signature:
405-461-6881 | [email protected] | 7 Microwave Hill Rd. Suite B Clancy, Mt. 59634 | kidzonemontessori.com