Child's Information

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Gender *
Grade Applying For *
Distance Learning
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Allergies, Medical Concerns, or Additional Needs

Failure to fully describe such items may result in a refused application or a safety risk to your child.
Does your child have any allergies, medical concerns, or additional needs? *
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Primary Parent/Guardian Information

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

Secondary Parent/Guardian Information

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

Parent Questions

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Please select the language you would like your child to study: *
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Parent/Legal Guardian's Signature *
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Teacher Recommendation & Release of School Records

Fountainhead conducts an assessment for internal purposes only of your child’s entry level skills and progress. This is a Fountainhead document and analysis only and is not part of the student record, will not appear in any student transcripts or files and at all times remains Fountainhead’s intellectual property and I understand and agree that I have no right to read, receive or obtain a copy of any such assessment.


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Parent/Legal Guardian's Signature *
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Agreement

1. I agree to pay, when due, fees specified in Fountainhead’s School Year Financial Information, a copy of which Iacknowledge having received. I understand I cannot withdraw from the Elementary school year once accepted into theprogram and have signed the Financial Agreement.
 
2. YOUR ASSESSMENT FEE IS NON-REFUNDABLE. If accepted into the Elementary program, it will be applied to your tuition and must accompany this application.
 
4. 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.

Parent/Legal Guardian's Signature *
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Authorization for Treatment

As the parent/guardian of the above named Student, I hereby give authorization to the staff of Fountainhead Montessori School to take my Student to an emergency room of the nearest hospital or urgent care facility should, for any reason, the Student require or reasonably appear to require any minor medical or surgical treatment and/or medication while participating in the activity set forth herein. I further authorize the hospital or urgent care facility and its medical staff to administer treatment as deemed necessary by them for the well-being of the Student.

I understand that the Fountainhead Montessori School staff will make attempts to notify me in all medical emergencies, and I will be contacted, if possible, for my permission if hospitalization or treatment is required.
I have read and understand the above and I freely give my consent and permission to all matters stated herein.
Parent/Legal Guardian's Signature *
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Participant Agreement

Voluntary Participation. The undersigned, the legal guardian of
(referred to herein as “Student”) acknowledges that participation in the activities set forth below is not part of the normal classroom program of Fountainhead, Inc., but desires that the Student participate in such activity. I acknowledge that such participation is voluntary, and but for the terms and conditions of this Agreement, the Student would not be allowed by Fountainhead, Inc. to participate. The activities are described as follows:
 
Supervised playground activities
 
Assumption of Risk. I AM AWARE THAT THIS ACTIVITY CONTAINS A DEGREE OF RISK WITH RESPECT TO THE SAFETY OF THE STUDENT AND THAT THE ACTIVITY IS NOT REQUIRED BY FOUNTAINHEAD, INC., NOR IS IT ONE THAT IS WITHOUT RISK OF INJURY. I AM VOLUNTARILY REQUESTING THAT THE STUDENT BE ALLOWED TO PARTICIPATE IN THE ACTIVITY WITH KNOWLEDGE OF THE DANGER INVOLVED, AND HEREBY AGREE TO ACCEPT ON BEHALF OF THE STUDENT ANY AND ALL RISKS OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE:
Release. As consideration for the Student being permitted by Fountainhead, Inc., to participate in the activity described herein, and all related elements of such activity, the undersigned hereby agree on behalf of themselves and the Student, and any and all other legal representatives, and to the extent allowed by law, that no claim will be made against Fountainhead, Inc., its, employees, officers, independent contractors or agents on account of any injury or damage resulting from the activity, howsoever caused. The undersigned hereby further fully and finally release Fountainhead, Inc., its, employees, officers, independent contractors or agents from all actions, claims, or demands, that the undersigned individually, or on behalf of the Student, now has or may have arising from the Student’s participation in the activity described herein.

Knowing and Voluntary Execution. I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN THE NDERSIGNED AND FOUNTAINHEAD, INC., AND I ACKNOWLEDGE AND AFFIRM THAT THIS AGREEMENT IS SIGNED BY THE UNDERSIGNED OF MY FREE WILL.

Parent/Legal Guardian's Signature *
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Payment Information

This payment option will be used to pay your tuition for the entire school year. You will continue to receive monthly statements from Fountainhead Montessori.
PLEASE NOTE: Once we receive your application, your account will be charged a $150.00 non-refundable assessment fee.

Payment Type: Credit Card
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Cardholder Signature *
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Payment Type: ACH
Please note that we only accept checking accounts
Please enter ACH information: