2022-2023 Enrollment Application

Apply online for admission to Riverbend Montessori School.

Enrollment Form: 2022-2023

"*" indicates required fields

1General

2Consent

3Medical

4Admissions

5Additional Info

6Registration Fees

7Financial

8Commitment

Student Information

Enrollment Type*

New Student

Re-Enrollment

Child’s Full Name*

First Middle Last

Date of Birth*

MM slash DD slash YYYY

Gender*

Age on 9/1/2022*

Race*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Number of Guardians*

How many parents or legal guardians does this child have?

Guardian 1 Information

Guardian 1 Relationship*

Father

Mother

Legal Guardian

Guardian 1 Name*

First Last

Guardian 1 Occupation & Employer*

Guardian 1 Business Phone*

Guardian 1 Cell Phone*

Guardian 1 Email*

Guardian 1 Facebook Email

only if different from primary email address

Guardian 2 Information

Guardian 2 Relationship*

Father

Mother

Legal Guardian

Guardian 2 Name*

First Last

Guardian 2 Occupation & Employer*

Guardian 2 Business Phone*

Guardian 2 Cell Phone*

Guardian 2 Email*

Guardian 2 Facebook Email

only if different from primary email address

Additional Family Information

Are Parent’s divorced?*

Yes

Who has custody?*

Emergency Contacts*

Relative or Friend who can be contacted in case of emergency (cannot be a parent). Add multiple by clicking the ⊕ icon.

Name

Phone

Relationship

Address

Pick Up Authorization*

The following persons (in addition to parents/guardians listed above) are authorized to pick up my child from Riverbend Montessori School. Add multiple by clicking the ⊕ icon.

Name

Relationship

Phone

Number of Siblings Enrolled at Riverbend Montessori for 2022-2023*

Name of sibling attending Riverbend Montessori for 2022-2023*

First Middle Last

Siblings Class for 2022-2023*

Transition

Primary 1

Primary 2

Lower Elementary

Upper Elementary

Name of sibling attending Riverbend Montessori for 2022-2023*

First Middle Last

Siblings Class for 2022-2023*

Transition

Primary 1

Primary 2

Lower Elementary

Upper Elementary

Siblings NOT attending Riverbend Montessori

Add multiple by clicking the ⊕ icon.

Name

Age

School

Grade

Relatives or Others Living in the Home

Add multiple by clicking the ⊕ icon.

Name

Relationship

Language(s) other than English spoken in the home

Consent

Snacks*

I understand that AM and PM snacks will be served to my child while in care.

I Understand

Field Trips*

Only applies to K-6th grade

I hereby give consent for my child to be transported and supervised by the operation’s employees on field trips

I do not give consent for my child to be transported and supervised by the operation’s employees on field trips

N/A - my child is younger than Kindergarten age

Water Activities*

Includes sprinkler play, splashing / wading pools, water table play

I hereby give consent for my child to participate in Water Activities

I do not give consent for my child to participate in Water Activities

Receipt of Parent Handbook*

Please download the Riverbend Montessori Parent Handbook which includes policies for discipline and guidance, arrival, dismissal and fees.

Download the Parent Handbook

I Acknowledge Receipt

Photo Release Policy*

I acknowledge receipt of the Riverbend Montessori Photo Release policy as written in the Parent Handbook.

I Acknowledge Receipt

Photo Release Permission*

I give permission for photos of my child to be used

I give permission except for Social Media use

I do not give permission for any photos of my child to be taken except for group pictures only

I do not give permission for any photos of my child to be taken and used

Emergency Care Information

Emergency Care Type*

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:

Physician

Medical Care Facility

Name of Physician*

Name of Emergency Medical Care Facility or Hospital*

Phone Number*

Address*

Street Address City State ZIP Code

Emergency Care Transportation*

I hereby give consent for my child to be transported and supervised by the operation’s employees for emergency care

I do not give consent for my child to be transported and supervised by the operation’s employees for emergency care

Emergency Medical Care Consent*

I give consent for the facility to secure any and all necessary emergency medical care for my child.

Emergency Medical Care Consent*

I give consent for the physician/facility to secure any and all necessary emergency medical care for my child (sign below).

Health Information

Health Care Providers Statement (HCPS)*

I will provide Riverbend Montessori the signed and dated Health Care Professional’s Statement (HCPS) on or before the first day of admission. I understand that my child will not be permitted to start school until this form is signed and returned.

Download HCPS Form

I Agree

Immunization Policy*

All children who enter Riverbend Montessori have been immunized per the Texas Minimum State Vaccine requirements for child care.

I Agree

Immunization Record*

I will provide Riverbend Montessori with a copy of my child's most current immunization record signed or stamped by their Physician on or before the first day of admission. I understand that my child will not be permitted to start school until this information is provided.

I Agree

Does your child have diagnosed allergies?*

Yes

Allergy and Anaphylaxis Emergency Care Plan*

I will provide Riverbend Montessori the signed and dated Allergy and Anaphylaxis Emergency Care Plan (FARE) on or before the first day of admission. I understand that my child will not be permitted to start school until this information is provided.

Download the FARE form.

I Agree

Special Needs*

Does your child have any special needs, such as environmental allergies, food intolerances, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregivers should be aware of?

Yes

Special Needs (Please Specify)*

Disallowed Foods?*

Yes

Disallowed Foods (Please Specify)*

Vision and Hearing Screening

Who must be screened:

4 years old by September 1st
Kindergartners
First time entrants to Riverbend Montessori (4 years through 6th grade)
1st, 3rd, 5th graders

Exam Results*

I will provide Riverbend Montessori with a copy of my child's screening results

My child will have their hearing & vision screening at Riverbend Montessori (at an additional cost). A Permission slip will be sent home closer to the screening date

Signature of Parent or Legal Guardian*

Additional Information

For new students only

Unusual Behavior*

Special Interests*

What made you choose Riverbend Montessori as the school for your child(ren)?*

Why Riverbend?

Expected Benefits*

Exit Grade Level*

Exit School Type*

Other Schools*

Goals*

Academic Concerns*

Social Concerns*

Classroom Assignment*

REGISTRATION & SECURITY DEPOSIT

Yearly Registration Fee*

I understand that there is a yearly registration fee of $200 or $250 per family with two or more siblings. I agree that this fee is due with the enrollment form, and once a space is offered and accepted, the fee becomes nonrefundable.

I Understand

Security Deposit*

I understand that a security deposit equal to one-half of one month’s tuition is due once an offer is made and accepted and it is nonrefundable. Payment of the Security Deposit secures my child’s enrollment. For re-enrolling families this amount is due at the time of registration.

I Understand

Security Deposit Withdrawal*

I agree that during the 2022-2023 school year, if I provide one month’s written notice of withdrawal, the security deposit will be applied to any outstanding tuition with the balance returned; otherwise it will be applied to May 2023 tuition.

I Agree

Tuition Schedule*

I understand that tuition may be paid in one yearly payment or in ten equal installments, August through May.

I Understand

Payments when Absent*

I agree that I am responsible for the entire monthly payment, regardless of the number of days absent.

I Agree

Returned Check Policy*

I understand that a fee of $25.00 will be charged on all returned checks.

I Understand

Late Fee*

I understand that a fee of $20 will be assessed for tuition paid after the 15th of the month.

I Understand

Late Pick Up Fee*

I understand that a $10 late pick up fee will be assessed after the last car in the line up has left for half day students. Full day students will be charged the after school care fee after the last car in the lineup has left.

I Understand

FINANCIAL AGREEMENT

Class*

Transition Class (18 months - 3 years old)

Primary Classes (3 - 6 years old)

Elementary Classes

Transition Class*

5 Half Days (Monday - Friday) 9:10 am - 12:00 pm

5 Full Days (Monday - Friday) 9:10 am - 3:00 pm

Payment Plan*

Annual ($9030)

Monthly ($903)

Payment Plan*

Annual ($9650)

Monthly ($965)

Primary Classes*

3-6 years old

Half Day (Monday - Friday) 9:00 am - 12:00pm

All Day (Monday - Friday) 9:00 am - 3:15 pm

Kindergarten (Monday - Friday) 9:00 am - 3:15 pm

Preferred Class*

Primary 1

Primary 2

No Preference

Payment Plan*

Annual ($8040)

Monthly ($804)

Payment Plan*

Annual ($10,090)

Monthly ($1009)

Payment Plan*

Annual ($10,090)

Monthly ($1009)

Parents are required to purchase a Nap Sack for all children (under 4 years old) who are full day students. Nap Sacks can be purchased through the Front Office at the beginning of the school year.

Activity Fee*

Required for ages 4 (full day only) through Kindergarten

Annual ($500)

Per Semester ($250)

N/A

Elementary Classes*

Lower (1st - 3rd Grade) 8:45 am - 3:45 pm

Upper (4th - 6th Grade) 8:45 am - 3:45 pm

Grade Level*

Payment Plan*

Annual ($10,730)

Monthly ($1073)

Payment Plan*

Annual ($10,990)

Monthly ($1,099)

Activity Fee*

Required for all Elementary grades

Annual ($575)

Per Semester ($287)

Please note: All students seeking to enroll in Elementary and who are new to the school are required to take an assessment test. The test fee is $50 and is non-refundable.

Extra Hours

There is a $1.00 late fee per minute/ per child for pick-up after 5:30 pm

Before Care (7:00 am to 9:00 am)

After Care (3:15 pm to 5:30 pm)

Before Care*

Monthly ($100)

Daily ($10)

After Care*

Monthly ($150)

Daily ($15)

Billing Email Preference*

Which email address should we use for billing purposes?

Guardian #1

Guardian #2

Other

School Year Commitment

Enroll for Complete School Year*

It is my intention to enroll my child for the complete school year, unless there are significant reasons for early withdrawal from school.

I Agree

Early Withdrawal Consequences*

I understand that early withdrawal procedures are in the Parent Handbook and will have financial consequences.

I Understand

Financial Responsibility*

Once my child has been offered a place at Riverbend Montessori, I understand this completed enrollment form, Registration Fee and Security Deposit secures my child’s admission and creates an assumed financial responsibility for the entire school year.

I Understand

Parent Signature*