Parental Agreement - Rising Star | A Montessori School

440 East Lanier Avenue
Fayetteville, GA. 30214
Phone: 770-461-1595
Fax: 770-629-1634
Parental Agreement with
20___ – 20___ School Year
1. Rising Star Montessori Academy (RSMA) agrees to provide instruction for my child
___________________________________ 5 days per week from __________a.m. to
__________a.m./p.m. to ____________________ to ____________________.
My child will furnish his/her lunch, beverage (milk), and cooler/freezer/ice pack in their lunch
container. The school will furnish morning and afternoon snacks (with the exception of two
weeks of morning snack for 20 students to be provided by student). My child will participate
in the following meal plan.
Please check the applicable meals/snacks ____morning snack____lunch____afternoon snack
2. Before any medication is dispensed to my child, I will provide a written authorization on
Rising Star Montessori Academy’s form which includes the date, child’s name, name of
medication, prescription number if any, dosage, date(s) and time(s) of administering. I will
present the medication in the original container with my child’s name marked on it.
3. Arrival/Dismissal – Class only children:
a. Primary: My child will not be allowed to enter or leave the school without being
escorted by the parents(s), person authorized by the parent(s), or the school personnel. My
child will be escorted to his/her classroom no earlier than 8:20 a.m. where a teacher is present
and will be signed in and out.
b. Junior Elementary: No signing in and out is required. My child will not be dropped off
earlier than 8:20 a.m.
c. Senior Elementary: No signing in and out is required. My child will not be dropped off
earlier than 8:05 a.m.
4. I acknowledge it is my responsibility to keep my child’s records current to reflect any
significant changes as they occur, e.g. phone numbers, work location, emergency contacts,
child’s physician, child’s health status, and immunization records, etc.
5. RSMA agrees to keep me informed of any incidents, including illnesses, injuries, adverse
reactions to medication, etc. which involve my child.
6. I acknowledge that it is my responsibility to keep the Academy informed as to any
contagious illness or disease my child has acquired which may have exposed other children at
the Academy and to keep my child home when she is ill. A signed medical release may be
required before my child may return to RSMA after certain illnesses, as noted on the DHR
Communicable Disease Chart. Students should be fever free, without medication, and have
not vomited for 24 hours before returning to school.
7. RSMA agrees to obtain written authorization from me before my child participates in
routine transportation, field trips, special activities away from school and water related
activities occurring in water that is more than two (2) feet deep.
8. In the event of any emergency involving my child and if RSMA cannot get in touch with me,
I hereby authorize any needed emergency medical care. I further agree to be fully responsible
for all medical expenses incurred during the treatment of my child. It is understood that in the
event of an accident of my child enrolled in the Academy, RSMA assumes no liability.
9. I authorize the use of my child’s name, parent name(s) address, phone number, and email
to be listed in the school directory which will be given to each parent near the beginning of
10. I give RSMA permission to use pictures of my child for advertising and informational
purposes in newspapers, school newsletters, and Rising Star Montessori Academy’s website.
11. I agree to pay tuition in advance by 6:00 p.m. on the first of each month in the amount of
$_______________per month. I understand that a LATE PAYMENT FEE will be assessed if the
above payment is not made on time. If payment has not been made by the end of the month,
the child will be refused admission to the school and further actions will be taken.
12. I have read this agreement and will abide by these policies and procedures for Rising Star
Montessori Academy.
Parent/Legal Guardian Signature________________________________Date______________