Camp Form | Venus Montessori School

PA Day & Weekend Camp APPLICATION

Please provide the child’s basic information exactly as it appears on official records.

Child Information

Child’s Family Name

First Name

Gender

Date of Birth

Year

Month

Day

Home Address (Street, City & Postal Code)

Preferred Contact Number

Doctor’s Name

Doctor’s Phone Number

Allergy and Food Restrictions (if any)

Parent / Guardian Information

Mother’s / Guardian’s Name

Mother’s / Guardian’s Phone Number

Mother’s / Guardian’s Work Phone Number

Mother’s / Guardian’s Email

Father’s / Guardian’s Name

Father’s / Guardian’s Phone Number

Father’s / Guardian’s Work Phone Number

Father’s / Guardian’s Email

Emergency / Pick-Up Contact

Emergency / Pick-Up Name

Emergency / Pick-Up Home Number

Emergency / Pick-Up Mobile Number

Emergency / Pick-Up Email

Camp Program Registration

Program Selection

Full Day

A.M. Program (8:45 AM – 12:00 PM)

P.M. Program (12:00 PM – 4:00 PM)

Extended Care Options

Before Care (7:30 AM – 8:45 AM) — $6/day

After Care (4:00 PM – 6:00 PM) — $10/day

Before & After Care (7:30 AM – 6:00 PM) — $15/day

None

Child Age Group

Toddler (1.5 – 2.5 years)

Casa (2.5 – 6 years)

School Age (6 – 10 years)

Program Fee

ENROLLMENT AGREEMENT

Your agreement to accept all of the following conditions is necessary in order for your child to be accepted for enrollment at the Venus Montessori School PA day and weekend Camp:

I hereby apply for registration for the herein-named child for the PA day and weekend camp sessions as indicated on this application form and give consent to receive email/electronic communications from VMS.

I / We acknowledge that before my child attends the PA day or weekend camp, we have to notice the school management at least 1 business days in advance, in order to make sure the ratio is correct and class materials, food are prepared in advance.

In the event of an accident or illness involving my child while my child is at school, I hereby authorize the administration of any medical procedure deemed necessary, including anesthetic, by the above - named Doctor, any Hospital Emergency Department, or by any other qualified physician.

I understand that during the course of my child’s daily activities in the school, injuries may occur. I agree to release and indemnify Venus Montessori School, and its affiliates, from any and all claims and damages arising as a result of any accident, injury or otherwise sustained by the herein named child arising from participating in any camp activities that is NOT caused as a result of the direct negligent act/omission of VMS and/or any of its staff.

I understand that various pictures and videos may be taken during the programs which may include my child, and I grant permission for their use throughout the school’s operation such that they may be displayed in the school, on the school’s websites, on promotional material, etc.

The 10 Full-Day and 10 Half-Day packages are considered pre-paid, flexible-use programs. These packages are non-refundable under any circumstances and do not carry an expiration date, Unused days may not be transferred, credited, or exchanged.

Mother’s / Legal Guardian Signature

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Date

Year

Month

Day

Father’s / Legal Guardian Signature

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Date

Year

Month

Day