Other Children in Family

List all schools attended from preschool to present:

Use the link below to download our Medical Verification form

Permission To Treat:

In the case of an accident, injury or illness, I authorize Rooted Life Montessori (administrators, faculty, staff or designated volunteers) to seek and obtain any medical help deemed necessary for my child.

I will not hold RLM liable in the case of illness or accidental injury.

I will not hold RLM responsible for any medical fees incurred.

In the event that I cannot be reached to make arrangements for emergency medical attention for my child at the time of an accident,injury or illness, I hereby authorize Rooted Life Montessori to call 911 and have my child transported to the nearest hospital emergency room and obtain any medical help deemed necessary for my child.

At Rooted Life Montesssori we use essential oil defusers in our classrooms. In some cases we may also use essential oils as topical treatments for minor ailments such as sun burn, bug bites, bee stings (unless there is a known allergy), cuts, bruises, scrapes, seasonal allergies, and upset stomachs. If you wish for your child to not receive topical treatments with essential oils or only with specific oils please let our staff know below.

Permission to Publish Images and Photo Release Policy

Rooted Life Montessori respects the privacy of our students and families first and foremost. For the purposes of promoting Rooted Life to the community, and potential enrolling families, the therapy center publishes images of our students captured while they are at work in their classrooms, on field trips, in musical productions, and during other therapy center events that provide an accurate and positive portrayal of student, parent, staff and faculty life at Rooted Life Montessori. For that reason, it is the goal of the therapy center to gain universal permission to include images and video of (all) students in promotional materials, including but not limited to: printed collateral, website content, Facebook posts, Weekly E-newsletter, videos, print media, signage, banners, display boards and more.

Our pledge for protecting your child/our students is supported by a set of precautionary rules and policies that are designed to facilitate promotion of the therapy center without compromising the safety and welfare of our students and families:

• Rules for Photographic Image Security
• The name of a student will never be disclosed on any advertisements, publicly distributed print materials or publicly accessible content including, but not limited to, social media, videos, therapy center website, and more without specific permission.
• Therapy centergenerated videos where the voice/s and images of students accompany video images will not accompany a student name.

Parents must send special request in writing if they wish for their child(s) image not be used in Rooted Life Montessori promotional materials (see list above), to the Administrator. When permission to publish images is denied, the result is that Rooted Life will exclude that child from class photographs, and small and large group photographs that would otherwise be perfectly suited for inclusion in the chosen media distribution format.

I hereby grant to Rooted Life Montessori, their successors, and their assignees the right to record the image and/or voice and use the artwork and/ or written work of my child, on videotape, on film, on photographs, in digital media and in any other form of electronic or print medium and to edit such recording at their discretion. I understand that my child’s full name, address and biographical information will not be made public.

I further grant Rooted LIfe Montessori their successors, and their assignees the right to use, and to allow others to use, my child’s image and/or voice on the internet, in brochures, and in any other medium and hereby consent to such use.

I hereby release Rooted Life Montessori, their successors, and their assignees and any using my child’s image and/or voice, artwork, and/or written work pursuant to this media release form any and all claims, damages, liabilities, costs and expenses which I or my child now have or may hereafter have by reason of any use thereof. I understand that the provisions of this release are legally binding.

PREFERENCE ASSESSMENT

The preference assessment is for us to learn about what your child likes, or what motivates them to complete activities and tasks. Please check the boxes below that match your child's preferences and fill out the below fields.

Much work goes into preparing an environment to prevent misbehavior. We require that children respect themselves, others and their environment. Children are given attention for appropriate and kind behavior. We use your child’s preferences to further motivate them toward appropriate behavior. Discipline means instruction. The teachers are trained to observe closely if children are not following classroom rules or responding to pivotal praise.

If a child's behavior is not normalizing with the implementation of Montessori philosophy and/or the child's behavior becomes a threat to the safety of other children or staff, the parent will be required to provide additional services such as counseling, ABA (Applied Behavior Analysis), or other behavior therapy at the parent's expense. If the parent does not wish to provide additional services, the child will be removed from the program without refund of the deposit or payments. While we work hard to ensure that every child is successful in our environment, we realize our classrooms and educational philosophy is not the right fit for every child or parent.

I understand that Discipline (training and instruction) must be:

1. Individualized and consistent for each child;
2. Appropriate to the child’s level of understanding; and
3. Directed toward teaching the child acceptable behavior and self-control.

The staff at RLM may only use positive methods of discipline and guidance that encourage self-esteem, self-control, and self-direction, which include at least the following:

1. Using praise and encouragement of good behavior instead of focusing only upon unacceptable behavior;
2. Reminding a child of behavior expectations daily by using clear, positive statements;
3. Redirecting behavior using positive statements; and
4. Using brief supervised separation or time out from the group, when appropriate for the child’s age and development, which is limited to no more than one minute per year of the child’s age.

There must be no harsh, cruel, or unusual treatment of any child. The following types of discipline and guidance are prohibited:

1. Corporal punishment or threats of corporal punishment;
2. Punishment associated with food, naps, or toilet training;
3. Pinching, shaking, or biting a child;
4. Hitting a child with a hand or instrument;
5. Putting anything in or on a child’s mouth;
6. Humiliating, ridiculing, rejecting, or yelling at a child;
7. Subjecting a child to harsh, abusive, or profane language;
8. Placing a child in a locked or dark room, bathroom, or closet with the door closed; and
9. Requiring a child to remain silent or inactive for inappropriately long periods of time for the child’s age.

My signature verifies I have read and received a copy of this discipline and guidance policy.

Rooted Life Montessori does NOT allow any forms of electronics on the campus for the children enrolled: iPad, tablets, phones, cameras, gaming devices, or basically anything that accepts batteries or an electrical power supply.

1st offense: the device will be taken from the child and returned at the end of the day.(Parent will receive notification of the event, but the teacher will allow the child to remedy the situation)

2nd offense: the device will be taken from the child and must be retrieved by the parent.

3rd offense: the child will be excused from class immediately to be picked up by the parent. The child will not be able to return for 7 days (a tuition refund will not be allowed).

If the parent is unable to retrieve the child, the child will be released to an authorized adult on the child’s Authorization For Release Form.

Children are enrolled for the academic year from Aug.-May. Tuition, Materials Fees, Testing Fees, etc. will not be adjusted due to absence, illness, withdrawal, or removal of the students by the parents. If parents stop sending their child to the Rooted Life Montessori Academic Therapy Center without giving a 2-week notice, payment is still required for the remainder of the entire semester that the withdrawal occurred. If you leave mid-contract, no payments will be refunded. The non-refundable enrollment deposit of $450/child secures the student's spot in class for the year. The deposit at registration represents your commitment to us and our commitment to your child before the term begins. Our commitment includes preparing the environment, purchasing materials, and hiring staff long before your child's first day of school. If any tuition payments are late, a late fee will be applied starting after the due date. A fee of $25 will be incurred every week until the payment is made.

I give permission for my child,

to participate in Pre -Admission testing offered by Rooted Life Montessori Staff. I understand that I am giving permission for the staff to determine the specific tests which would reveal my child’s areas of strength or weakness to determine an individualized education or therapy plan. The fee charged for this testing will include a follow-up meeting to go over the results. I also understand that I will receive a written report indicating how my child performed on this test. I may choose at that time whether to allow my child to participate in any of the therapeutic programs that may be recommended.