Child's Information

Child's First Name *

Child's Last Name *

Child's Birthday * +

Gender *

M

F

Desired Start Date * +

Is your child returning to Fountainhead Montessori (previously enrolled)? *

Yes

No

Does your child have a sibling currently enrolled at Fountainhead? *

Yes

No

Please select a campus *

Danville

Livermore

Pleasant Hill

n/a

Please select class *

Toddler/Prep Class (18 months - 2.5 years)

Toddler/Prep (18 months - 2.5 years)

Primary Class (2.5 years - 6 years)

Please select the days for the class times you would like your child to attend.

Choose any schedule of two (2) or more days days per week. Please note 4 day schedules are not available.

Please select the days for the class times you would like your child to attend.

Choose any schedule of three (3) or five (5) days per week.

Before and after care is available from 7:00 am to 9:00 am and 12:00 pm to 6:00 pm

Before and after care will be available from 7:00 am to 9:00 am and 12:00 pm to 6:00 pm

Schedule Options *

AM Only: 9:00 am - 12:00 pm

AM and PM: 9:00 am - 12:00 pm/1:00 pm - 4:00 pm

PM Only: 1:00 pm - 4:00 pm

AM: 9:00 am - 12:00 pm NOT *

Total Scheduled Days *

AM: 9:00 am - 12:00 pm DAN *

AM: 9:00 am - 12:00 pm LIV *

AM: 9:00 am - 12:00 pm ORI *

AM: 9:00 am - 12:00 pm PHIL *

Select format of PM Primary class *

English

Spanish Immersion

NOTE: Immersion programs are 5 days per week.

PM Primary: 1:00 pm - 4:00 pm LIV *

Select format of PM Primary class *

English

Mandarin Immersion

Spanish Immersion

NOTE: Immersion programs are 5 days per week.

PM Primary: 1:00 pm - 4:00 pm DAN1 *

Select format of PM Primary class *

English

Spanish Immersion

Mandarin Immersion

NOTE: Immersion programs are 5 days per week.

PM Primary: 1:00 pm - 4:00 pm ORI1 *

PM Primary: 1:00 pm - 4:00 pm ORI2

Select format of PM Primary class *

English

Spanish Immersion

Mandarin Immersion

NOTE: Immersion programs are 5 days per week.

PM Primary: 1:00 pm - 4:00 pm PHIL1 *

Allergies, Medical Concerns, or Special Needs

Please describe all allergies, medical conditions, or additional needs your child may have. Failure to fully describe such items may result in a refused application or a safety risk to your child.

0/1000 characters

Allergies or Medical Conditions Confirmation *

Yes, I have listed them above

No, child has no known allergies or medical conditions

Primary Parent/Guardian Information

First Name P1 *

Last Name P1 *

Relationship to ChildP1 *

Address P1 *

City P1 *

ST P1 *

Zip P1 *

Cell Phone P1 *

Home Phone P1

Work Phone P1

Most communications are via email only. Your email will be used for only FMS communications.

Email Address (Submission confirmation will be emailed to this address) P1 *

Confirm Email *

Secondary Parent/Guardian Information

First Name P2

Last Name P2

Relationship to ChildP2

Address P2

City P2

ST P2

Zip P2

Cell Phone P2

Home Phone P2

Work Phone P2

Most communications are via email only. Your email will be used for only FMS communications.

Email Address P2

Confirm Email

Payment Information

If your desired schedule is available, your first month’s tuition will be collected using the account information you enter below.

If you are looking to be placed on our wait-list for a future start date, select 'Waitlist' under payment type, below. Tuition will be collected after we confirm your start date. There is no charge to be placed on our wait-list.

Please choose a payment type *

Payment Type: Credit Card

Please enter credit card information:

PLEASE NOTE: a 2.6% transaction fee is applied to credit card purchases. Please initial. *

Name on Credit Card *

Type of Card *

Visa

Master Card

Discover

American Express

Card No. *

Exp Month *

Exp Year *

CVV *

Payment Type: ACH

Please Note that we only accept checking accounts

Please enter ACH information:

Account Holder(s) Names *

Name of Financial Institution *

Bank Routing No. *

Bank Account No. *

Agreement

1. I agree to pay, when due, fees specified in Fountainhead’s School Year Financial Information, a copy of which I acknowledge having received. Subject to the provisions of paragraph 2 below, in the event I wish to withdraw my child from school, I will give thirty (30) day’s written advance notice or pay thirty (30) day’s tuition.

2. WITHDRAWALS ARE NOT ALLOWED AFTER JULY 1st unless you pay tuition through mid-August (the academic year).

3. YOUR FIRST INSTALLMENT IS NON-REFUNDABLE unless Fountainhead cannot accommodate your child. It will be applied to your first installment charges and must accompany this application. Your selected start date is a firm date. Your tuition will not be prorated due to incomplete paperwork or for any other reason.

4. I have read and understood the policies (see Policies & Procedures) in Fountainhead’s brochure, a copy of which I acknowledge having received and reviewed. I understand and acknowledge that these policies are subject to change from time to time at the discretion of Fountainhead’s Board of Directors, provided that there will be no change in the fees or tuition payable without thirty days advance notice. Please initial below. *

5. A confirmation of your application and additional paperwork will be sent to you. If you do not receive it, it is your obligation to contact Fountainhead promptly.

Signing Parent/Guardian's Full Name *

Use mouse (or finger - if on a touch screen) to sign.

Signature of Parent/Guardian *

clear

Today's Date *