Blue River Montessori School
Application Form
Please print and send with $75 non-refundable application fee to:
484 Temple Street, Duxbury, MA 02332-2917
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DATE: SCHOOL YEAR OF INTEREST:
NAME OF CHILD: MALE / FEMALE (CIRCLE ONE)
BIRTH DATE: AGE AT LAST BIRTHDAY:
PREVIOUS SCHOOL(S) ATTENDED:
IS YOUR CHILD FULLY TOILET-TRAINED? YES/NO
PROGRAM OF CHOICE (CIRCLE TWO--INDICATE FIRST CHOICE BY MARKING WITH AN ASTERISK):
MORNING (4 Days/Week: Monday through Thursday)
AFTERNOON (4 Days/Week: Monday through Thursday)
MORNING (3 Days: Specific days subject to availability)
AFTERNOON (3 Days: Specific days subject to availability)
MORNING (2 Days/Week: Monday & Wednesday)
MORNING (2 Days/Week: Tuesday & Thursday)
AFTERNOON (2 Days/Week: Monday & Wednesday)
AFTERNOON (2 Days/Week: Tuesday & Thursday)
MORNING (1 Day: Specific day subject to availability)
AFTERNOON (1 Day: Specific day subject to availability)
NAME OF FATHER: OCCUPATION:
HOME ADDRESS OF FATHER:
FATHER'S HOME PHONE: WORK: CELL:
FATHER'S EMAIL ADDRESS:
NAME OF MOTHER: OCCUPATION:
HOME ADDRESS OF MOTHER:
MOTHER'S HOME PHONE: WORK: CELL:
MOTHER'S EMAIL ADDRESS:
WITH WHOM IS THE STUDENT LIVING?
TO WHOM SHOULD CORRESPONDENCE BE SENT?
WHO IS FINANCIALLY RESPONSIBLE FOR EDUCATIONAL EXPENSES?
FOREIGN LANGUAGE(S) SPOKEN AT HOME:
SIBLINGS (PLEASE LIST NAMES AND BIRTH DATES):
DOES YOUR CHILD RECEIVE PROFESSIONAL SUPPORT OR HAVE ALLERGIES, ASTHMA,
ANY RESTRICTIONS, OR SPECIAL MEDICATIONS? IF SO, PLEASE EXPLAIN:
RESTRICTIONS/SPECIAL MEDICATIONS:
HOW DID YOU HEAR ABOUT US?
1. Tuition payments and fees must be paid by appropriate due dates, in accordance with option selected at
enrollment, or reserved space is subject to forfeiture. All late payments will be subject to a 10% finance charge. A
fee of $50.00 per occurrence is charged for returned checks. The school policy is to not admit children if fees have
not been fully paid by the above dates. The school reserves the right to withhold records if tuition has not been
paid as stated above. Application fees and enrollment deposits are non-refundable.
2. Children who arrive earlier than 8:55 a.m. or are picked up later than 12:05 p.m. for the morning session and
children who arrive earlier than 12:05 p.m. or are picked up later than 3:15 p.m. for the afternoon session will be
charged a $1.00 per minute fee per child, payable at pickup. I understand that Blue River Montessori School
(BRMS) assumes no legal responsibility for my child until BRMS staff accepts custody of my child at arrival;
conversely, I understand that BRMS assumes no legal responsibility for my child once BRMS staff releases my
child to me at dismissal. BRMS follows the Duxbury Public School (DPS) calendar regarding days in session,
holidays, and half-days (no afternoon sessions), with two exceptions: BRMS is closed on the Wednesday before
Thanksgiving, and the school year ends on the first Friday in June. BRMS follows DPS with regard to inclement
weather closings, delays, early closings, and Professional Development Days.
3. Pupils are registered for an entire year or from the time the child is accepted into the program until the end of
the year. Pupils are registered once deposit is received by BRMS. No reduction will be made for absence or
withdrawal before the end of the year, or for forfeited space due to late payment. Regardless of the date of
withdrawal, parents or guardians are responsible for the entire year’s tuition once registered.
4. I understand that I must submit to BRMS all forms in the enrollment package, and I understand that my child
will need to receive all necessary immunizations prior to his/her first day of attendance.
5. I understand that my submission of this application form does not in itself guarantee acceptance until my child
is accepted by Blue River Montessori School and I am notified. When accepted, a non-refundable $1000.00 deposit
is required in order to register and reserve a space for the above named child in the Blue River Montessori School
program for the school year. Blue River Montessori School accepts children regardless of race, color, creed, or
national origin.
I hereby apply for a place in Blue River Montessori School for my child, ___________________________, for the
school year beginning_______________. I have enclosed my non-refundable application fee. I have carefully read
the foregoing, the statements above, and the fee schedules for the school, and in consideration of the reservation
of a place for the above child for the school year, I hereby agree to comply with the terms expressed in the
statements above and to be bound by the school regulations as they are established and amended from time to time.
Signature______________________________________ Date______________________________
*Please also sign and date the first page of application if printing on two separate pages.