If you would prefer to fill this Registration Form out by hand, you may download it here:  DOWNLOAD
If you are choosing to download, please Skip to the next form (Grandparent Contact Form).

This is a full registration form.

Please be prepared to enter Medical Information as well as Emergency Contact Information before continuing.

For ease of use, this form is set to save partially submitted data for a short period of time (depending on your browser permissions). If you are submitting registration for a second student, you will have the option to "reset" the form after submission.

Included with your welcome letter, was your child’s LMS#. With this number, when you submit registration for your child, your household information will automatically update in our database. We ask that you please take your time in order to submit full and accurate information.

Student Information

 
Yearly Health Assessment (routine physical) is required for your student prior to the first day of school.

 

 

Parent Information

 

Parent/Guardian 1

Please *click* on the google suggested address
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It is required by the State of CT that parent work contact information be kept on file.
Please *click* on the google suggested address
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Parent/Guardian 2

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Please *click* on the google suggested address
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It is required by the State of CT that parent work contact information be kept on file.
Please *click* on the google suggested address
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Medical Information

(e.g. Northwest Hill Pediatrics)

Allergy Action Plan  

Students that have an allergy that may need treatment at school, an allergy action plan must be completed to act as a guide. Parent and Doctor signatures are required. 

You may DOWNLOAD the file now, or when you are on the Health Assessment page.

(e.g. Anthem Blue Cross, HUSKY)
Person who holds the coverage for the family

Authorization for Administration of Medication Form

Students receiving or taking any medication (including over the counter drugs) during school hours must have form signed by physician.

You may DOWNLOAD the file now, or when you are on the Health Assessment Form Page. 

 

 

Emergency Contact Information

 (Two people we can call if you cannot be reached in case of emergency)

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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 complete 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.

Please give a small explanation of why you declined this release so we know it was intentional.

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 to 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) in which my child participates. 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.

Please give a small explanation of why you declined this release so we know it was intentional.

Electronic Representation/Photo Release 

Photo’s within our LMS community: 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 share the photographs, video, digital, and/or sound recording made during my child’s or my family’s participation in Litchfield Montessori activities, with members of the Litchfield Montessori School Community, and I hereby release Litchfield Montessori, and its representatives from any and all liability from such use and publication.

Photo’s outside our LMS community: 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 names of the people, 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.

Please give a small explanation of why you declined this release so we know it was intentional.

Permission to Travel with Volunteer Drivers

I hereby give permission for my Elementary child to accompany their class on field trips away from the school. I understand that adults will supervise all such trips and that my child will be transported in a private vehicle that will be driven by either a staff member, a parent volunteer, or bus. All volunteer drivers sign the Volunteer Driver Agreement, in which they assume responsibility for specific license, insurance, and vehicle requirements and in which they assume responsibility and liability for any incident that occurs while transporting students off school property.

Please give a small explanation of why you declined this release so we know it was intentional.

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.

Sign above
 
Litchfield Montessori is affiliated with AMI (Association Montessori Internationale) and accredited by CAIS (Connecticut Association of Independent Schools) not the Office of Early Childhood.