Idyllwild Montessori School

53785 Country Club Dr, Idyllwild, CA 92549 MAIL: PO BOX 1328, Idyllwild, CA 92549 (646)706-1513

SUMMER SCHOOL REGISTRATION FORM

PLEASE PRINT

PROGRAM HOURS: 9:00 AM - 3:00 PM

I do ......./ I do not ......wish to have my child participate in the Summer Program

STUDENT'S NAME: _____________________________________________________________________

STUDENT'S AGE: ______________________PROGRAM HOURS: ______________________________

PARENTS NAME: ______________________________________________________________________

ADDRESS: ____________________________________________________________________________

______________________________________________________________________________________

TELEPHONE (Home): ___________________(Work):: _________________________________________

PERSONS TO BE CALLED IN CASE OF EMERGENCY:

PERSONS AUTHORIZED TO TAKE CHILD FROM SCHOOL:

Second page

Name of person responsible of payments __________________________________________

Signature of person responsible for payment ______________________________________

Social Security Number of above person: ________________________________________

Billing name and address: ____________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Parents Signature: _____________________________________