Summer Registration

Parent/Guardian 1

Emergency Policy and Release

The school agrees to notify the parent/guardian if the student becomes ill, and the parent/guardian agrees to pick up the student as soon as possible. The parent/guardian agrees to inform the school immediately if the child or any member of the immediate household has developed a communicable disease or lice. If the child must take medication at school, the parent/guardian agrees to compete the Authorization to Administer Medication Form and deliver the medication to the school in its original packaging. The parent/guardian authorizes the school to obtain immediate medical care in the case an emergency occurs when he or she cannot be located immediately. In a medical emergency your child will be taken to the NEAREST HOSPITAL EMERGENCY ROOM.

Parent or Guardian Release

I understand that Litchfield Montessori School's outdoor activities occur in diverse terrain. I authorize my child to participate fully in all of Litchfield Montessori School’s activities. I understand that Litchfield Montessori School cannot safeguard against all such injuries, and I expressly agree such risk and waive, release, save and hold harmless Litchfield Montessori School, its officers, agents, employees, and federal, state, or local agencies which have jurisdiction over lands or properties upon which The Litchfield Montessori School operates, from any claim of liability, settlement, judgment, award or cost of defense and attorney's fees, including negligence, except gross neglect, by Litchfield Montessori School for any loss, damage, or injury incurred during the program(s) which my child is participating in. I attest that my child has been fully informed of the program activities and agrees to participate. I agree fully to disclose all physical, mental and emotional conditions that could impact the safety or success of the program. It is agreed that any dispute or cause of action arising between the parties, whether out of this agreement or otherwise, can only be brought in a court of competent jurisdiction located in Litchfield County, CT and shall be construed in accordance with the laws of Connecticut.

I understand that during the course of school activities, photographs, video, electronic representation and/or sound recordings make be taken of students, siblings, parents, other family members and visitors to Litchfield Montessori school, including my child/children. I hereby assign and grant to Litchfield Montessori, the right and permission to use and publish the photographs, video, digital and/or sound recording made during my child’s or my family’s participation in Litchfield Montessori activities, and I hereby release Litchfield Montessori, and it representatives from any and all liability from such use and publication. I further authorize reproduction, sale, copyright, exhibit, broadcast, electronic storage and/or distribution of said photographs, film, video, and/or sound recordings without limitation at the discretion of Litchfield Montessori School, and I specifically waive any right to compensation I, my child, or my family may have for any of the forgoing. I understand the the names of the persons, including my child, may also be included to identify persons in the photographs, video, or digital representations and/or sound recordings. I further understand and acknowledge that said photographs, film, videotape, electronic representations and/or sound recordings may be displayed on bulletin boards, local television, newspaper, website, school fundraising activities, programs or special events, and school publications.

Electronic Signature Authorization

By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable. By electronically signing and submitting this agreement, I 1) acknowledge that I have read and fully understand the terms of the agreement; 2) voluntarily agree to be bound by this agreement; and 3) certify that I am 18 years of age or older. My signature applies to all pages of this contract. I understand that if I wish to sign a hard copy of this agreement instead of an electronic version, I must contact the party that requires my signature on this agreement directly.