ENROLLMENT

Enrollment

Enroll Your Child in Our Montessori Academy Today!

Application & Enrollment Forms

If you are considering enrolling your child in Sunshine Montessori Academy, welcome! Please fill out the form below or download the pdf to start the process. Contact us for more information and to turn the forms in.

Download Eckhert Admission Forms

If filling out the online form below- you MUST also have your provider fill out the Physician Statement and Food Allergy Emergency Plan and attach the completed files to the form below before submitting.

Physician Statement Form

Food Allergy Emergency Plan

Online Enrollment Form

Desired Location - Choose One

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ADMISSION INFORMATION

Directions: The parent or guardian must fill out this form entirely and must return it to the facility no later than the morning of the child’s first day of enrollment. We will keep these forms on file in the facility and will be updated by the parent as needed by SMA to comply with Texas Childcare Licensing Minimum Standards. Forms must be completed in blue or black ink only.

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CHILD’S INFORMATION:

Name:

Date of Birth:

Child’s Home Address:

Phone:

State:

Sex:

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PARENTS’/GUARDIAN INFORMATION:

Father’s/Guardian Name:

Home Address:

City:

State:

Zip:

Cell #:

Cell Phone Provider (Verizon, AT&T, etc.)

Work#:

Email:

Mother’s/Guardian Name:

Home Address:

City:

State:

Zip:

Cell #:

Cell Phone Provider (Verizon, AT&T, etc.)

Work #:

Email:

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PRIMARY ACCOUNT HOLDER:

T his parent or guardian will be the main account holder for all the payment information. Any ledger cards, tax forms, and receipts will be in the primary account holder’s name.

Full Name:

Parents’ Marital Status:

If other, please explain:

Child lives with:

If guardian, provide name:

Custody Documents on File:

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PARENT OR GUARDIAN PRIMARY EMERGENCY CONTACT INFORMATION:

This is the parent or guardian with whom we can get in contact with quickly in case of an emergency.

Name:

Relationship:

Phone Number:

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EMERGENCY CONTACT INFORMATION: Must be other adult besides the parents or guardians

Full Name:

Relationship:

Address:

City:

State:

Zip:

Cell #:

Work #:

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AUTHORIZED TO PICK UP THE CHILD: One may be the same as the emergency contact

The authorized pick person must be other adults besides parents.

1) Full Name:

Phone #:

Relationship:

2) Full Name:

Phone #:

Relationship:

3) Full Name:

Phone #:

Relationship:

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❖ I authorize Sunshine Montessori Academy to release my child to leave the facility ONLY with the authorized persons listed above. Children will only be released to a parent or guardian or person designated by the parent or guardian after verification of identification.

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AUTHORIZATION FOR EMERGENCY MEDICAL ATTENTION:

In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to:

Child’s Physician:

Phone #:

Address:

City:

State:

Zip:

Emergency Medical Care Facility:

Phone #:

Address:

City:

State:

Zip:

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I give consent for Sunshine Montessori Academy to secure any and all necessary emergency medical care for my child and I will be responsible for the applied costs:

Signature of Parent or Legal Guardian:

Date:

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MEDICAL INFORMATION:

List any special problems that your child may have, such as environmental allergies, food intolerances, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months and from birth of the child. Any medication prescribed for long-term continuous use and any other information which caregivers and management should be aware of:

Does your child have a doctor diagnosed food allergy?

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A separate form must be submitted for each doctor diagnosed food allergy

Plan submitted on: (office use only)

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Child care operations are public accommodations under the Americans with Disabilities Act (ADA), Title III. If you believe that such an operation may be practicing discrimination in violation of Title III, you may call the ADA information line at (800) 541-0301 (voice) or (800) 514-0383 (TTY).

Signature of Parent or Legal Guardian:

Date:

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CONSENT INFORMATION: Please consent to all that apply

1) TRANSPORTATION: I hereby _____ my consent for my child to be transported and supervised by Sunshine Montessori Academy employees

Give

Do NOT Give

New Field:

for emergency care

on field trips

2) FIELD TRIPS (ages 5 thru 12): I hear by _______ my consent for my child to participate in field trips.

Give

Do NOT Give

3) WATER ACTIVITIES: I hereby ______ my consent for my child to participate in water activities.

Sprinkler play during summer time

Water table play

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MEALS:

Sunshine Montessori Academy is currently enrolled in the Federal Food Program through the Texas Department of Agriculture and will serve the following meals to your child: Breakfast, Lunch and Afternoon Snack.

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SCHEDULE:

Part Time students will need to sign up for the same days each week and will only be able to change or substitute upon director approval. Not all requests will be approved

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MONDAYS:

From:

To:

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TUESDAYS:

From:

To:

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WEDNESDAYS:

From:

To:

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THURSDAYS:

From:

To:

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FRIDAYS:

From:

To:

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SCHOOL AGE CHILDREN:

My child attends the following school

Name of School:

Phone #:

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Authorized Pickup/drop off locations other than the child’s address:

Address:

City:

State:

Zip:

My child has permission to:

Ride a bus

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ADMISSION REQUIRMENTS:

If your child does not attend pre-kindergarten or school away from Sunshine Montessori Academy, the following must be provided:

Shot Record: We must receive an updated shot record to be placed in your child’s file every time your child gets a vaccination. If your child is not current with licensing standards, we will not be able to care for your child until they are up to date.

Physician Statement: We have provided a physician form for your child’s doctor to fill out and sign to be placed in your child’s file. Form must be filled out completely and a stamp from the doctor’s office included in the designated spot. This form must be submitted within one week of your child’s first day of enrollment.

Vision and Hearing Screening: The results of your child’s vision and hearing test must be submitted to be placed in their file once your child turns four years old.

Signature of Parent or Legal Guardian:

Date:

REQUIREMENTS FOR EXCLUSION:

I have attached a signed and dated affidavit stating that I decline immunization for reason of conscience, including religious belief, on the form described by Section 161.0041 Health and Safety Code submitted no later than the 90th day after the affidavit is notarized.

I have attached a signed and dated affidavit stating that the vision or hearing screening conflicts with the tenets or practices of a church or religious denomination that I am an adherent or member of.

Varicella (chickenpox) vaccine is not required if your child has had chickenpox disease. If your child has had chickenpox, please complete the following statement:

My child had varicella disease (chickenpox) on or about the date of _________________ and does not need varicella vaccine.

Signature of Parent or Legal Guardian:

Date:

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Gang Free Zone:

Under the Texas Penal Code, any area within 1,000 feet of a childcare center is a gang-free zone, where criminal offenses related to organized criminal activity are subject to harsher penalties.

Name of Parent or Guardian Completing Form:

Date:

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PLEASE FILL OUT THE PHYSICIAN STATMENT AND FOOD ALLERGY EMERGENCY PLAN AND ATTACH THE COMPLETED DOCUMENTS (These are located at the top of this page)

New Field:

↑ UPLOAD Completed Physician Statement

New Field:

↑ UPLOAD Completed Food Allergy Emergency Plan

New Field:

↑ UPLOAD Additional Completed Food Allergy Emergency Plan (if needed)

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For Office Use Only:

Date of Enrollment: ___________________ Director: ___________________________

Date of Disenrollment: ________________ Director: ___________________________

Sunshine Montessori Academy, San Antonio, TX

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