Clear Form

THE SPRINGS admits students of any race, religion, creed, color, and national or ethnic origin. The records of all students are confidential and are available to parents or guardians by request. Requests for records will only be released to other parties upon signed request from the parent or guardian, and only after all accounts are paid in full.

☐ 2021-22
☐ Summer Camp 2022
☐ 2022-2023

Child

☐ M
☐ F
☐ Other:
☐ Infant House (6 weeks - 20 months) (8:00 am - 5:00 pm)
☐ Toddler House: Half Day (20 months - 3 years | 8:15am - 12:00 pm)
☐ Toddler House: Full Day (20 months - 3 years | 7:00am - 6:00 pm))
☐ Children's House: Half Day (3-6 years old | 8:15am - 12:00 pm)
☐ Children's House: Full Day (3-6 years old | 7:00am - 6:00 pm)
☐ School Day (5-6 years old only | 8:15am - 3:00 pm)

Parent 1

Parent 2

My child lives with:

Background Information

Please Introduce Us To Your Child

Please list the name of any schools, daycares or other childcare programs your child has attended and the years they have attended.
Please put N/A if no allergies
Please put N/A if no restrictions

*An additional Allergy Action Plan will need to be completed for any child with allergies. If medication is required at school a separate Medication Authorization Form must be completed.

*Please note that the Commonwealth of Virginia requires all children under the age of 5 in a full day program to rest for at least 30 minutes every day.

Agreement Contract

Indicating yes on the following statements and/or questions is akin to signing and agreeing. The application will not be processed unless all statements and/or questions have been made in the affirmative.

Virginia Department of Social Services requires that schools verify the identity of all children enrolled in our program. This is to assist with the identification of missing children and to verify the age of each student. Acceptable forms of identification include your child’s birth certificate, passport, certified notification of birth from a hospital, physician or midwife, or adoption/foster placement agreements. All documents presented must be ORIGINAL and will be documented and returned to you immediately. Identity Verification must be completed upon enrollment and no later than your child’s first day of school.
All students are required to submit a Virginia School Entrance Health Form that is signed and dated by a physician. Your child’s physician must certify that your child is up to date on his or her immunizations or certify that your child is medically or religiously exempt form immunization requirements. If applicable, the Virginia Form for Religious Exemption must be notarized and accompany your child’s Health Form. The Health Form must be submitted prior to your child’s first day of school. Additionally, an updated Health Form must be submitted between your child’s 4th and 6th birthdays to reflect updated immunizations. A yearly physical must be documented for elementary students.
I have received THE SPRINGS’ Parent Handbook (available at www.springsmontessori.com). I understand and agree to abide by the policies, procedures, rules and regulations set forth in the Handbook for the academic period in which I am enrolling my child and all future academic periods to include any subsequent Parent Handbook changes. The policies set forth are to protect and ensure your child’s safety. Understanding and complying with the Handbook will help to make your school experience more enjoyable and seamless.
I acknowledge that my child’s name, as well as my name will be listed in my child’s classroom directory which is only accessible through a secure login via the school’s online platform.
I acknowledge that my child’s photograph may be taken within school events for use within the school community (e.g., bulletin boards, newsletters, private online portal, etc.). Additionally, I acknowledge that my child’s photograph may be taken and used in publications, videos, social media, and other mediums for public use associated with THE SPRINGS. Names of children will not be released without additional parental consent.
I understand that THE SPRINGS sends SMS (TEXT) Alerts out to all families who have listed a cell phone number. This message is sent via School Messenger and it is the family’s obligation to opt in or out of the messaging service. I agree to abide by the terms and conditions of my cellular provider and am 100% responsible for any charges incurred by my cellular provider for receiving any SMS (TEXT) alerts sent by THE SPRINGS.
I understand that THE SPRINGS routinely sends email messages out to all families who have listed an email address. These messages are sent through a variety of platforms and it is the families’ obligation to opt in or out of the messaging services. I agree to abide by the terms and conditions of my email provider and am 100% responsible for any incidents associated with receiving any email messages sent by THE SPRINGS.
I hereby give permission for my child to be transported via bus* to and from field trips away from the school grounds, unless the school receives written notice from me to the contrary. Additionally, I hereby give my permission for my child to be transported to the field trips by a licensed and insured driver. I understand that when my child is transported in the car, the driver will follow all safety precautions, including the use of seat belts. I will provide a child safety seat as required by Virginia Law. *Please note that Virginia law does NOT require safety seats on the school bus*
I understand that for any individual, other than the parents listed on application, to have approval to pick up my child from school I must complete a Pick Up Authorization Form. This form will be provided before my child’s first day of school. All individuals picking up children will be required to present ID. Pick up authorizations will not be approved by telephone.
The individuals listed below are restricted from picking up my child. Please provided appropriate legal documentation, if applicable,
If there is a custody agreement (or one is subsequently agreed to) for my child, I agree to provide a copy to the school prior to the first day of school. I also agree that if any subsequent agreement were to be made, it will be provided to the school immediately.
I give my permission to The Springs, A Montessori School and their teachers to help clean my child if they have any toileting accident. Children’s House teachers will only intervene at the request of the child or when it is visibly apparent that the child is unable to clean him or herself completely.
I understand that at times the school must be closed due to inclement weather and other emergencies. THE SPRINGS does not possess the resources or technology to determine widespread weather conditions. Additionally, the school must ensure property conditions are safe for students and faculty and that we can be fully staffed to provide care for your children. Therefore, THE SPRINGS follows FAIRFAX COUNTY PUBLIC SCHOOLS for school closings, delays, and early closings due to precipitation. Please consult the Parent Handbook for further information. THE SPRINGS makes every attempt to make up any snow days as determined by FAIRFAX COUNTY PUBLIC SCHOOLS. However, the school year will not be extended in any way.
I understand THE SPRINGS utilizes audio and/or video surveillance within the school and its grounds. I understand that my child and anyone else I bring onto the premises may be recorded. Furthermore, I consent to this surveillance. I understand that the recordings are on a private system and only the Administration of THE SPRINGS have access to the recordings. Any parent at any time can view the recordings under the supervision of an Administrator.

Community Health Agreement

I understand that my child is joining a school community that, in addition to my child, consists of other students, teachers, and family members of students and faculty. THE SPRINGS works very hard to protect the health of all members of our community and reserves the right to send ill children home at the discretion of the School Administration, each of whom has completed the Virginia Daily Health Observation Training. However, these individuals, while trained to identify potential illness, are not medical personnel and cannot diagnose illnesses. Indicating yes on the following statements and/or questions is akin to signing and agreeing. The application will not be processed unless all statements and/or questions have been made in the affirmative. Therefore, I agree to the following:

Terms and Conditions of Enrollment

Indicating yes on the following statements is akin to signing and agreeing. The application will not be processed unless all statements have been made in the affirmative.

Agreement required regardless of program choice
Agreement required regardless of program choice
Agreement required regardless of program choice

Legal

Submission Agreement

By submitting this application (pressing the submit button) and digitally signing below (entering your name(s)), we as the responsible parties of the applicant, fully agree to all items listed herein and any policies set forth by The Springs, A Montessori School including but not limited to any future policy changes made at THE SPRINGS’ discretion.

Please note that you must have express consent to sign on behalf of another parent or guardian. The Springs is not held liable for failure to obtain such consent.