Student Information *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Student Primary Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian 1 Name *

First Name

Last Name

Phone *

(###)

###

####

Parent/Guardian 2 Name

First Name

Last Name

Phone

(###)

###

####

Please select 3- or 5-day enrollment. *

3-Day T/W/Th

5-Day M-F

Going Outs and Field Trips *

Experience beyond the classroom is essential to a Montessori education. By checking the box below, I agree to let my child participate in these out of school excursions. Permission slips and outing details will be provided per trip.

I understand and support the importance of student experience beyond the classroom.

Authorization for Outdoor Play and Work *

This authorization grants permission for your student to participate in outdoor experiences on campus.

Yes, my child has permission to work and play outdoors.

CPR and First Aid *

By checking this box, I authorize the staff of Program who are trained in the basics of first aid/CPR to give my child first aid/CPR when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached and a delay would be dangerous to the health of my child, I hereby authorize the program to transport my child to a medical care facility and to secure necessary medical treatment for my child, including, but not limited to, an epinephrine auto-injection for suspected exposure to a life threatening allergen.

I have read the above and agree.

Media Release

Promoting the activities and accomplishments of our students throughout the year gives our community the opportunity to see the great things taking place in our program. Therefore, photos and videos of students may be taken in connection with program activities or events for printed/online publications, newsletters, website stories, social media, and other publications.

I DO give permission for my child's photo/video to be taken.

I DO NOT give permission for my child's photo/video to be taken.

Authorized Pick-Up 1

First Name

Last Name

Phone

(###)

###

####

Authorized Pick-Up 2

First Name

Last Name

Phone

(###)

###

####

Authorized Pick-Up 3

First Name

Last Name

Phone

(###)

###

####

Authorized Pick-Up 4

First Name

Last Name

Phone

(###)

###

####

Parent/Guardian Signature *

By checking the box below, I acknowledge that I have read and agreed to the terms and expectations laid out in the Student and Family Handbook linked below. Wildwood Field School Student and Family Handbook.pdf

I have read and agree to the Student and Family Handbook.