Visit Day Release Form

Your child’s visit day is an important piece of the application process. This informal assessment allows both your child and us an opportunity to get to know each other better. Your child will spend the day with us, experiencing a typical school day in a Montessori classroom.

Child's Name

First Name

Last Name

Child's Visit Date

YYYY

Parent One - Name

First Name

Last Name

Parent One - Phone

(###)

###

####

Parent Two - Name

First Name

Last Name

Parent Two - Phone

(###)

###

####

Emergency Contact - Name

First Name

Last Name

Emergency Contact - Phone

(###)

###

####

Pickup Person - Name

First Name

Last Name

Pickup Person - Phone

(###)

###

####

Is there any information regarding your child’s health we should know?

(Medications, chronic illness)

Does your child have any dietary restrictions?

Does your child have any allergies? If yes, check all that apply

Food

Medication

Seasonal/Pollen

Other

Please describe the specific allergen(s)

I hereby certify that while my child visits Montessori School of Fort Worth, s/he will be in the care of school teachers/staff. In the event my child becomes ill or is accidentally injured, and I cannot be reached, I hereby grant permission for my emergency contact person listed above to pick up my child. In the case of a medical emergency, I give my permission for my child to be transported to the closest hospital for emergency treatment. In addition, I hereby give my consent to the hospital and staff to treat my child.

Yes

Your electronic verification is your consent to allow your child to visit Montessori School of Fort Worth.

First Name

Last Name

Date Signed

YYYY