DUPAGE DISCOVERY CAMPAT

DUPAGE MONTESSORI SCHOOL

ENROLL NOW!www.dupageschool.org

630-369-6899

Lego Camp

Dinosaur Camp

Toddlers Explor

ing!

Chess Camp

Young Scientists

T-Ball Camp

SUMMER 2014

Welcome to DuPage Discovery Camp

atDuPage Montessori School

DUPAGE DISCOVERY CAMP at DuPage Montessori School is here! We are happy to present our Summer Camp Program Guide for 2014. We have exciting camps and field trips for the children to enjoy this summer. Our favorites return along with some new summer locations: the Planetarium for our Space Camp, Peck’s Farm with a butterfly house, the Field Museum for Dinosaur Camp, and Sarah’s pony rides and farm animal petting zoo.Our experienced, carefully selected, and well-trained staff have diverse backgrounds working with children. They bring their talents and enthusiasm to connect with each child’s unique personality and interests.Adam Darlage: Adam is our upper elementary teacher and holds a Ph.D. in History from the University of Chicago. Adam brings his love of history, cultures and languages to his students each day. He enjoys playing sports with his students and makes each day an exciting day of learning.Hadley Woodhouse: Hadley is our lower elementary teacher (6-9 yrs.) with a Masters in Education from DePaul University. Hadley’s background is in English and History and she is also a certified Art teacher. Hadley creates a curriculum to fit each child’s needs incorporating inspiring art projects to extend the process of learning.Chris Styles: Ms. Chris is a teacher in our Early Childhood (3-6 yrs.) program. Chris enjoys teaching with a hands on approach to creating materials and bringing in real life teaching experiences to her students. Chris has a passion for teaching the science camps (Dinosaurs, Bugs, Space Camp and Ocean Life) by bringing in new projects and incorporating Field Museum learning materials for the children to explore. Chris Dyslin: Chris teaches music for all ages during our regular school year and is a certified Music Teacher. She is well versed in everything from finger play with our younger students to Broadway musicals with our older students. Prabha Rajan: Prabha is an assistant in our Early Childhood (3-6 yrs.) program. She enjoys teaching arts and craft throughout the year at our school and is constantly creating new projects based on our curriculum.Colleen Breen: Colleen is an assistant in our Early Childhood (3-6 yrs.) program. She will be working in the Montessori classrooms during the summer.Robin Azarela: Robin is our teacher assistant with the first through third grade students throughout the year. She will teach the Horsing Around Camp, Art with the Masters Camp and Creation Station. Nelly Chatterjee: Nelly has taught for 21 years at our school, which shows her passion to teach and her dedication to her students. Nelly will be teaching in the Early Childhood (3-6 yrs.) program during the summer. Aileen Valencia: Aileen has been teaching for 19 years at our school. Her understanding of the Montessori approach shows in her patience and dedication to each student in her classroom. Aileen will be teaching in the Early Childhood (3-6 yrs.) program during the summer months.Maha Arakoni: Maha is a teacher in Early Childhood (3-6 yrs.) program and will teaching in the 3-6 yrs. classes and some camps as well. Maha has been with us as a parent, teaching intern and a teacher. She is a dedicated teacher that has the love of children as her guide in the classroom. Lynn Griffin: Lynn is a teacher in our Early Childhood (3-6 yrs.) program. She is essential in creating and coordinating the Summer Program and Camps we offer. Lynn will be teaching Space Camp this summer. Ken Diehl: Ken is a retired high school science teacher and performed demonstrations with his students at the Sci-Tech Museum. in Aurora. Ken will be teaching the Young Scientist Camp this summer. Evelyn Hermosa: Evelyn has been working with us through high school and college and is currently a pre-medstudent. She is a certified Zumba instructor and will be teaching sports camps as well.We are looking forward to a fun and exciting summer!

Thank You, Bob and Sharon Breen, Directors

MontessoriEarly Childhood Classes (3-6 yrs.)

Classes are taught by Montessori Teachers.

Ages: 3-6 yearsHalf Day Hrs: 9:00 a.m.-12 p.m.! 1:00 p.m.-4:00 p.m.Full Day Hrs. Available: 7:30 a.m.-6:00 p.m.

Themes !Week 1-Summer GardenWeek 2-On the Farm -*Pony RidesWeek 3-Exploring MusicWeek 4-Ocean LifeWeek 5-Celebrate AmericaWeek 6-All About Nutrition -*Lou Malnati’s Week 7-Mad Science-*Science WorkshopWeek 8-Community Helpers Week 9-Woodland AnimalsWeek 10-Color Creations Week 11-Beach Party ! ! ! ! ! * Field Trips

Elementary Educational Classroom Instruction

Ages: Elementary ClassesHalf Day Hrs: 9 a.m.-12 p.m., 1:00 p.m.-4:00 p.m. Full Day Hrs. Available: 7:30 a.m.-6:00 p.m.The Elementary teachers will offer individualized instruction for academic skills, along with their daily instruction. They will take exciting field trips and enjoy many more summer activities.

Summer Field Trips

Week 2- Peck’s FarmWeek 3- Ceramics Field TripWeek 4- Shedd Aquarium!!Week 6- Lou Malnati’s Pizzeria!Week 7- Science Workshop- In School!Week 8- Adler PlanetariumWeek 9- Medieval Times/ Lunch & Show!Week 10 -Legoland

CHOOSE FROM OUR PROGRAMS(Discovery Camps are for children ages 4 - 6 years old & Elementary)

Discovery Camps(Minimum 10 students per class)

Ages: 4 - 6 years Hours: 9 a.m. - 12 p.m.

Ages: 6 yrs. may choose a.m. or p.m. camps.

Ages: Elementary Camps: 1st-8th gradesHours: 1 - 4 p.m.

Extended Hours:Extended hours are availablebefore and after, the camps and educational programs.

EARLY MORNING Times: 7:30 a.m. to 9 a.m.

AFTER CARE Times: 4 p.m. - 6 p.m.

Rates for Discovery Camps and Classes are based on 5 consecutive week days.

$25 Credit for Each “NEW” Referral

(New Sibling, Friend) Relative, Neighbor)

Summer CampsMATH, SCIENCE & ENGINEERING CAMPS

#202 It’s a Bug’s World Instructor: Ms. ChrisDate: Week 2, June 9-13 *(FT)Ages: 4 - 6 yrs: a.m.Elementary: p.m.

We’ll look at other specimens to compare similarities and differences. We’ll also take an up close look at spiders to learn why they aren’t insects. PM campers will learn that insects are the most diverse animals on the planet. There are more than a million species of insects, representing more than half of all known living organisms.They will have an opportunity to invent their own insect. Field Trip Peck’s Farm with a Butterfly House in Geneva.

#802 Space ExplorationInstructors: Ms. Lynn a.m., Mr. Adam, Ph.D., p.m.Date: Week 8, July 21-25*(FT) Ages: 4 - 6 yrs: a.m., Elementary: p.m.

In this camp, children will spend a fun-filled week learning about space as they explore and create their own our solar system. Their imaginationswill be expanded by the vastness of space. Field trip to Adler Planetarium in Chicago.

#701 Young Scientists Instructors: Ms. Prabha a.m. and Mr. Ken p.m.Date: Weeks 7, July 14-18(FT)Ages: 4 - 6 yrs: a.m.Elementary: p.m.

Be a mad scientist in the DMS lab, with hands-on experiments and creative concoctions. Scientific concepts are really going to stick as you learn basic principles and watch them come alive right before your eyes. Projects include: Chinese rocket, Hover craft, Cartesian diver and Helicopter craft.

Science Workshops in school.

#801 Diggin’ DinosaursInstructor: Ms. Chris Date: Week 8, July 21-25 *(FT)Ages: 4 - 6 yrs: a.m Elementary: p.m.

Who came first Allosaurus or TRex? In this camp we actually set up a fossil dig! There will be dinosaur models and we’ll measure the biggest and the smallest.P.M. campers will study the Mesozoic Era -Triassic, Jurassic and Cretaceous Periods. Since dinosaur fossils are usually found embedded in rock, paleontologists associate dinosaurs with the geologic period in which they lived--for example, "the sauropods of the late Jurassic." Field trip to the Field Museum in Chicago.

#901 Animals in Your Neighborhood Instructor: Ms. RobinDate: Week 9, July 28- Aug. 1Ages: 4 - 6 yrs: a.m. Elementary: p.m

Campers will learn about the animals living in their backyards, parks and forests. They will learn about their habitats and learn the importance of our native animals. The will create their own animal book.

! * Field Trips 3

#401 Under the SeaInstructor: Ms. ChrisDate: Week 4, June 23-27*(FT)Ages: 4 - 6 yrs: a.m.Elementary: p.m.

There’s more than fishin the sea! There are forests of kelp and black smokers. We’ll begin by learning about fish habitats and where in the ocean they live. We’ll make fish prints, taste seaweed, learn that starfish are not fish at all, and not all that lives in the ocean, swims. They will work on creating their own ocean ecosystem.Field trip to the Shedd Aquarium in Chicago.

STUDIO ARTS & CRAFT CAMPS (Cont.)

#101 Garden ArtInstructor: Ms. PrabhaDate: Week 1, June 2-6Ages: 4 - 6 yrs: a.m.Elementary: p.m.

Summer begins by exploring the garden through colors and patterns. We explore the different types of gardens, learn about planting and create art projects around our theme.

#301 Ceramics and Clay Instructor: Ms. Prabha Date: Week 3, June 16-20*(FT)Ages: 4 - 6 yrs: a.m. Elementary: p.m.

Campers will use their imaginations by moulding clay and painting ceramics.Field Trip to “Color me Mine” to create a ceramic piece.

This camp will focus on different artists such as: Van

Gogh, Monet, Casset and DaVinci. We will learn a brief history of the artist we are replicating along with different painting techniques and skills.

#902 Photography Instructors: Ms. Maha a.m., Ms. Prabha, p.m. Date: Week 9, July 28-Aug. 1 Ages: 4 - 6 yrs: a.m., Elementary: p.m.

Campers will learn the basics of photography and camera use, as well as a brief history about the origin of photography. Younger students will learn how to operate a camera and take successful pictures. Older students will learn how to operate a camera, and go more in depth with the functions. Campers need to supply their own disposable cameras.

! ! ! ! *(FT) Field Trip

#703 Young Authors AMInstructor: Ms. Chris Date: Week 7, July 14-18Ages: 4-6 yrs: a.m.

Campers will learn the parts of a story (beginning, middle and end) and create the characters and plot by using their drawings and magazine pictures.They will be shown examples of different stories, brainstorm ideas, draw pictures, write and share each others stories.

#703 Creative Writing PMInstructor: Mr. Adam, Ph.D.Date: Week 7, July 14-18Elementary: p.m.

Students explore creative writing through storyboarding, short stories, and poetry. The focus is on the fundamentals of good fiction writing: the construction of plot, (beginning, middle, end), setting, and character development.  The instructor uses creative techniques to instill a love of writing.

#302 Theater CampInstructor: Ms. Chris DyslinDate: Week 3, June 16-20Ages: 4- 6 yrs: a.m., Elem: p.m.

In this musical theatre camp, students will have funimproving their singing, dancingand musical theatre acting skills.They will perform in a small musical at the end of the week.

STUDIO ARTS & CRAFT CAMPS#803 Messy ArtInstructor: Ms. PrabhaDate: Week 8, July 21-25Ages: 4- 6 yrs am: Elem: p.m.

This camp explores art with color, shapes and design! Splatter art, squish painting, color mixing and hands on experiences!

4

LANGUAGE, MUSIC & LITERATURE

#402 Art with the Masters Instructor: Ms. RobinDate: Week 4, June 23-27Ages: 4 - 6 yrs: a.m., Elementary: p.m.

5

#603 Creation Station (AM ONLY)Instructor: Ms. RobinDate: Week 6, July 7-11Ages: 4-6 yrs.

Creations will include toothpicksculptures, modeling clay dough,pine cone creations, and a week long project using paper-mâché.

EXPLORATION CAMPS#203 When in Rome... (PM ONLY)Instructor: Mr. Adam, Ph.D., HistoryDate: Week 2, June 9-13Ages: Elem. p.m

Students explore the history, culture, and geography of ancient Rome as well as the Latin language. Students will build a model of the Colosseum with other fun projects, including building battle formations with toy Roman soldiers. 

#903 Castles, Knights and Queens! *(FT)Instructors: Ms. Prabha a.m. Mr. Adam, Ph.D., HistoryDate: Week 9, Jul. 28-Aug 1Ages: 4 - 6 yrs: a.m.,Elem: p.m.

Children will use different materials to construct and

decorate their castle. In the PM, Mr. Adam will teach the history of Europe during the Medieval time period and explore the lives of the royalty, tradesman and farmers. Field Trip to Medieval Times, including a meal and performance.

#1001 Legos *(FT)Instructors: Ms. Prabha a.m. Mr. Adam p.m.Date: Week 10, Aug 4 - 8Ages: 4 - 6 yrs: a.m. Elementary: p.m.

Put your engineer’s cap on and come explore everything with LEGO building. In this camp children will design and assemble their own models. Field trip to LEGOLAND Discovery Center in Schaumburg.

#201 Horsing Around (AM ONLY)Date: Week 2, June 9-13Instructor: Ms. Robin Ages: 4 - 6yrs.

Children will learnabout the care of a pony and equipment such as; the saddle, reins and bridle.Field trip to our Wheaton school for a pony ride and petting zoo with farm animals.

#601 Young Chefs Instructor: Ms. PrabhaDate: Week 6, July 7-11 *(FT)Ages: 4 - 6 yrs: a.m. Elementary: p.m.

Children will learn measurements, basic cooking skills and recipes for making snacks that donot require any cooking. At the end of the week they will come home with their very own cookbook. Field Trip to Lou Malnati’s Pizzeria in Naperville to make a pizza.

#602 Chess (PM ONLY)Instructor: Mr. AdamDate: Weeks 6, July 7-11Ages: 5 - 6 yrs.(Child must be able to read) Elementary: p.m.

This is a fun and exciting way to learn about chess. No previous experience is necessary. Each class will consist of time spent learning the basics of chess througha guided teaching period and time spent solving problems using logic.

*(FT) Field Trip

SPORTS CAMPS

#303 T-Ball Camp/SoftballDate: Week 3, June 16-20Ages: 4 -6 yrs. a.m. - T-Ball Elementary p.m. -Softball

Young campers will learn thebasic introduction to T-ball and Softball including hitting, catching, and throwing. They will have fun and learn about team work.

#102, #1101 SoccerDate: Weeks 1 & 11, June 2-6, Aug 11-15Ages: 4 - 6 yrs. - a.m. Elementary p.m.

This is a great way for campers to get outside and be active while learning valuable skills to help with coordination, teamwork and self-confidence.

#501, #1002 All Sports Date: Weeks 5 & 10, June 30-Jul. 3, August 4-8Ages: 4 - 6 yrs. a.m., Elementary p.m.

This camp is designed for campers who want to learn a new sport each day. The campers will participate in basketball, kickball, soccer and many other team activities. The various sports allows for building a variety of skills, allowing each child to find something fun and to fit each child’s abilities. Participating in sports builds a child's self-esteem while teaching teamwork.

#403, #702 ZUMBA Date: Week 4, June 23-27 Week 7, July 14-18Ages: 4 - 6 yrs. a.m.Elementary p.m.Instructor: Ms. Evelyn, Certified Zumba Instructor

This camp is for kids who like to turn up the music, wiggle, and giggle. This camp is mixed with a dynamic aerobics and obstacle course challenging for kids.

#604 Kickball, Red Rover, Freeze TagDate: Week 6, July 7-11Ages: 4- 6 a.m. Elementary p.m.

Regular active play helps children to develop a lifelong habit of daily exercise. Children will learn how to play the age old games that gave us joy in our childhood. The children will learn team sportsmanship and different strategies for different games. They will also get an understanding of social rules, build friendships, get a sense of 'give and take', and learn patience and perseverance.

*Water bottles requested daily for sport camps. Bring your own soccer balls,basketballs, softballs and mitts.All personal items must be labeled with children’s name.

6

* Field Trip 7

WEEK 1

2 3 4 5 6 7

WEEK 2

9 10 11 12 13 14

WEEK 3

16 17 18 19 20 21

WEEK4

23 24 25 26 27 28

JUNE

#101 GARDEN ART #102 SOCCER

#201*HORSING AROUND (AM ONLY) #202 * IT’S A BUG’S WORLD #203 WHEN IN ROME (PM ONLY)

#301 *CERAMICS & CLAY #302 THEATER CAMP #303 T-BALL/SOFTBALL

#401 *UNDER THE SEA #402 ART WITH THE MASTERS #403 ZUMBA

WEEK 5

JUNE 30 1 2 3 Closed 4 5

WEEK 6

7 8 9 10 11 13

WEEK 7

14 15 16 17 18 19

WEEK8

21 22 23 24 25 26

#501 ALL SPORT

#601 *YOUNG CHEFS #602 CHESS (PM ONLY) #603 CREATION STATION (AM ONLY) #604 KICKBALL, RED ROVER

&

#701 *YOUNG SCIENTISTS #702 ZUMBA #703 AM: YOUNG AUTHORS #703 PM: CREATIVE WRITING

#801 *DIGGIN DINOSAURS #802 *SPACE CAMP #803 MESSY ART

WEEK 9

28 29 30 31 1 2

WEEK 10

4 5 6 7 8 9

WEEK 11

11 12 13 14 15 16

JULY/AUG

#901 ANIMALS IN YOUR NEIGHBORHOOD #902 PHOTOGRAPHY#903 *CASTLES, KNIGHTS, and QUEENS

#1001*LEGOS #1002 ALL SPORT

JULY

#1101 SOCCER

Summer at a Glance

ProgramsAM Early Morning

Care7:30 -9am

CAMPSAM: 9 - 12___4-6 Yrs

PM: 1 - 4___6-12 Yrs

Class OnlyHALF Days___AM: 9 -12___ PM: 1 - 4___ 3-6 Yrs___ 6-12 Yrs

Full Day + Camp

___4-6 Yrs___6-12 Yrs

Full Day9 - 4pm

PM Care4-6pm Field Trip Fee Total

WeeklyFees: $15

Circle One Camp$150

$130Circle One

Camp$250 $230 $20

$25*(Except Medieval

Times- $45)

Please total all boxes below

Week 16/2 - 6 Fee: _____

101 Garden Art102 SoccerFee: ______

Fee:_____101 Garden Art102 SoccerFee: ______

Fee:_____ Fee:_____

Elementary will go on all field trips w/ camps. *3-6 yrs. will go: Weeks 2, 6 & 7

Week 2 6/9 - 13 Fee:_____

201 Horses am202 Bugs203 Rome pmFee: ______

Fee:_____201 Horses am202 Bugs203 Rome pmFee: ______

Fee:_____ Fee:_____

*Pony Rides: 3-6 yrsor

Bugs Camp/ElemPeck Farm

$25

Week 36/16 - 20 Fee:_____

301 Ceramics302 Theater303 T-Ball/SoftFee: ______

Fee:_____301 Ceramics302 Theater303 T-Ball/SoftFee: ______

Fee:_____ Fee:_____Ceramics/Elem.Color Me Mine

$25

Week 46/23 - 27 Fee:_____

401 Sea402 Art403 ZumbaFee: ______

Fee:_____401 Sea402 Art403 ZumbaFee: ______

Fee:_____ Fee:_____Under the Sea Camp/Elem.

Shedd Aquarium $25

Week 56/30 - 7/3 Fee:_____ 501 All Sport

Fee: ______ Fee:_____ 501 All SportFee: ______ Fee:_____ Fee:_____

Week 67/7- 7/11 Fee:_____

601 Chefs602 Chess pm603 Creation am604 KickballFee: _______

Fee:_____

601 Chefs602 Chess pm603 Creation am604 KickballFee: _______

Fee:_____ Fee:_____*Cooking Camp/

3-6 yrs./Elem*Lou Malnati’s

$25

Week 77/14-18 Fee:_____

701 Scientists702 Zumba703 WritingFee: ______

Fee:_____701 Scientists702 Zumba 703 WritingFee: ______

Fee:_____ Fee:_____*Science

Workshops$25

Week 87/21 - 25 Fee:_____

801 Dinosaurs802 Space803 Messy ArtFee: ______

Fee:_____801 Dinosaurs802 Space803 Messy ArtFee: ______

Fee:_____ Fee:_____Dinosaurs

Field MuseumSpace Camp

Adler Planetarium

Week 97/28 - 8/1 Fee:_____

901 Animals902 Photo903 CastlesFee: ______

Fee:_____901 Animals902 Photo903 CastlesFee: ______

Fee:_____ Fee:_____Castles Camp

Medieval Times*$45

Week 108/4 - 8/8 Fee:_____

1001 Legos1002 SportsFee: ______

Fee:_____1001 Legos1002 SportsFee: ______

Fee:_____ Fee:_____Lego Camp/Elem

Legoland $25

Week 118/11 - 8/15 Fee:_____ 1101 Soccer

Fee: ______ Fee:_____ 1101 SoccerFee: ______ Fee:_____ Fee:_____

TOTAL:

PARENT’S COPY - KEEP FOR YOUR SCHEDULE

ProgramsAM Early Morning

Care7:30 -9am

CAMPSAM: 9 - 12___4-6 Yrs

PM: 1 - 4___6-12 Yrs

Class OnlyHALF Days___AM: 9 -12___ PM: 1 - 4___ 3-6 Yrs___ 6-12 Yrs

Full Day + Camp

___4-6 Yrs___6-12Yrs

Full Day9 - 4pm

PM Care4-6pm Field Trip Fee Total

WeeklyFees: $15

Circle One camp$150

$130Circle One

camp$250 $230 $20

$25(Except

Medieval Times- $45)

Please total all boxes below

Week 16/2 - 6 Fee: _____

101 Garden Art102 SoccerFee: ______

Fee:_____101 Garden Art102 SoccerFee: ______

Fee:_____ Fee:_____

Elementary will go on all field trips w/ camps. *3-6 yrs. will go: Weeks 2, 6 & 7

Week 2 6/9 - 13 Fee:_____

201 Horses am202 Bugs pm203 RomeFee: ______

Fee:_____201 Horses am202 Bugs pm203 RomeFee: ______

Fee:_____ Fee:_____

*Pony Rides: 3-6 yrsor

Bugs Camp/ElemPeck Farm

$25

Week 36/16 - 20 Fee:_____

301 Ceramics302 Theater303 T-Ball/SoftFee: ______

Fee:_____301 Ceramics302 Theater303 T-Ball/SoftFee: ______

Fee:_____ Fee:_____Ceramics/Elem.Color Me Mine

$25

Week 46/23 - 27 Fee:_____

401 Sea402 Art403 ZumbaFee: ______

Fee:_____401 Sea402 Art403 ZumbaFee: ______

Fee:_____ Fee:_____Under the Sea Camp/Elem.

Shedd Aquarium $25

Week 56/30 - 7/3 Fee:_____ 501 All Sport

Fee: ______ Fee:_____ 501 All SportFee: ______ Fee:_____ Fee:_____

Week 67/7- 7/11 Fee:_____

601 Chefs602 Chess pm603 Creation am604 KickballFee: _______

Fee:_____

601 Chefs602 Chess pm603 Creation am604 KickballFee: _______

Fee:_____ Fee:_____*Cooking Camp/

3-6 yrs./Elem*Lou Malnati’s

$25

Week 77/14-18 Fee:_____

701 Scientists702 Zumba703 WritingFee: ______

Fee:_____701 Scientists702 Zumba703 WritingFee: ______

Fee:_____ Fee:_____*Science

Workshops$25

Week 87/21 - 25 Fee:_____

801 Dinosaurs802 Space803 Messy ArtFee: ______

Fee:_____801 Dinosaurs802 Space803 Messy ArtFee: ______

Fee:_____ Fee:_____Dinosaurs

Field MuseumSpace Camp

Adler Planetarium

Week 97/28 - 8/1 Fee:_____

901 Animals902 Photo903 CastlesFee: ______

Fee:_____901 Animals902 Photo903 CastlesFee: ______

Fee:_____ Fee:_____Castles Camp

Medieval Times*$45

Week 108/4 - 8/8 Fee:_____

1001 Legos1002 SportsFee: ______

Fee:_____1001 Legos1002 SportsFee: ______

Fee:_____ Fee:_____Lego Camp/Elem

Legoland $25

Week 118/11 - 8/15 Fee:_____ 1101 Soccer

Fee: ______ Fee:_____ 1101 SoccerFee: ______ Fee:_____ Fee:_____

TOTAL:

Child’s Name ______________________________________________ Age________

SCHOOL COPY - KEEP FOR YOUR SCHEDULE

Summer Application2014

Du Page Montessori School24 W. 500 Maple Ave.Naperville, IL 60540

630-369-6899

Child Information: Male Female

___________________________________________________________First Middle Last Name

_______________ ______ ___________________________________Date of Birth! Age Place of Birth

Early Registration Fee $15 -Due by April 30.Registration Fee $30 (non-refundable)

Programs: 3 - 6 years Elementary

Parent (Guardian) Information:

________________________________________________Mother’s Name

________________________________________________Mother’s home address

________________________________________________City State Zip

________________________________________________Home phone: area code - number

________________________________________________Mother’s Cell phone: area code - number

________________________________________________Mother’s Email Address

________________________________________________Mother’s Occupation

________________________________________________Mother’s Company Name

________________________________________________Company City State Zip

________________________________________________Company phone: area code - number

Marital Status (circle one): married, single, divorced

Parent (Guardian) Information:

_______________________________________________Father’s Name

_______________________________________________Father’s home address

_______________________________________________City State Zip

_______________________________________________Home phone: area code - number

_______________________________________________Father’s Cell phone: area code - number

_______________________________________________Father’s Email Address

_______________________________________________Father’s Occupation

_______________________________________________Father’s Company Name

_______________________________________________Company City State Zip

_______________________________________________Company phone: area code - number

Marital Status (circle one): married, single, divorced

Child’s brothers and sisters:_________________________ _________________________Name Age Name Age_________________________ _________________________Name Age Name Age

Important Health Information:Allergies: __________________________________________ __________________________________________________Health Restrictions:_____________________________________________________________________________________Physical Impairments:_________________________________

Permissions: I grant permission to the school to take my child on school sponsored field trips, and to include him or her in school photographs and evaluation programs.

! _____________________________________! ! _________________! ! Signature of Parent or Guardian ! ! ! date