Madison Montessori Info Booklet

Madison Montessori Academy
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Information
Booklet
If you are interested in registering your child please read, complete all
forms and return this booklet to Madison Montessori Academy!
Thank you
Copyright 2012
Madison Montessori Academy
2965 hwy. #43
Kemptville, ON
P.O. Box 1919
K0G 1J0
Table of Contents
Choosing A Pre School For Your Child............................................................5
The Architect Of Montessori...........................................................................6
The Genius Of Montessori.............................................................................8
Curriculum...................................................................................................10
Testimonials..................................................................................................11
Rotating Four Week Menu.............................................................................13
Application for Admission..............................................................................14
Emergency Record For classroom....................................................................17
Physician.......................................................................................................18
Student Questionnaire...................................................................................19
Release Form.................................................................................................21
Tuition Fees...................................................................................................22
Notes.............................................................................................................23
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Madison Montessori Academy
“The essential thing is for the task to
arouse such an interest that it engages the child’s whole personality.”
- Dr. Maria Montessori
Madison Montessori Academy
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Choosing A Pre School For Your Child
Choosing a preschool for your child is one of your most important responsibilities as a parent.
If you’re like most parents, you want your children to be educated in an environment where their
intellectual abilities and self esteem grow hand-in-hand, where imagination and curiosity are cultivated,
where critical thinking and competencies flourish, where students learn to respect all cultures and all people,
and where teachers care deeply for the whole person who is their student….and your child. We believe that
Madison Montessori Academy is such a place.
Madison Montessori Academy is a diverse learning community where independence, positive self esteem,
critical thinking, responsibility to self and others and a peaceful, appreciative stewardship of the earth are
fostered in each and every student.
In addition to providing the many extras you’d expect from a private education, Madison Montessori
Academy is also a Montessori learning environment. Our faculty are trained montessorians, well versed
in this century old educational philosophy. Our school offers the most complete curriculum of
Montessori education in both our Toddler and Casa programs.
“Lay A Solid Foundation For
Your Child’s Future”
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Madison Montessori Academy
The Architect Of Montessori
Why Montessori Students exhibit genius.
This is not an environment that stimulates genius:
it is an environment that genius must overcome.
Genius cannot be acquired via a production line.
By Judith Cunningham
There is a growing library of research and a great deal
of talk about what comprises “genius,” how it occurs
and why it is exhibited by those who have it. One
theory that was quickly put to rest was that those with
an IQ of 125 or more exhibit genius. The inventor of
the transistor received a Nobel Prize, but since his IQ
was below the benchmark, he would not, therefore,
have qualified to be known as a genius. Thomas
Edison invented the electric light, the microphone,
the voice recorder, the motion picture camera and
so many other items that he still holds more issued
patents from the US patent office than any other
individual. Yet he was such a poor student that his
mother had to tutor him at home. Again, IQ was
not the indicator, but surely he qualified as a genius.
As an aside, later in his life Edison quickly recognized
the genius of Maria Montessori and sponsored her
work in the United States.
Research reflects that genius, and acts of genius,
can also occur in less striking ways than the dramatic
insight of Michelangelo developing perspective for his
work on the ceiling of the Sistine Chapel or DaVinci’s
legacy of his multiple talents in the arts and sciences.
The ability to think “outside the box” and the courage
to be unafraid of intellectual or creative risk “because
it is different, or might fail” are equally marks of
genius. The capacity to intuit something different
within a set of established facts is also a sign of
genius. Penicillin, Post-It-Notes, the ink-jet printer,
and, of course, gravity were all the results of
serendipitous observations fueled by genius.
Researchers refer to this ability to recognize what
others had seen before but had failed to act upon,
as “the prepared mind.” The focus of Montessori is
to prepare the mind. From the first steps into the
prepared environment of a Montessori Toddler or
Casa classroom, to the last step from the stage at
graduation, every activity in the classroom and
every experience in the school has been planned
with the thought of “preparing the mind and the
emotional heart.”
More recently, a genius has been described as
someone who “brought about change by introducing
new principles into existing thought.” By that
measure, Shakespeare, Mozart, Einstein, Curie and
Salk were all geniuses. The history books are dotted
with a short list of thinkers who changed their worlds.
Obviously Maria Montessori falls into this category.
Through her careful observations, she came to
understand that children “are not empty vessels into
which information is poured,” but rather they have a
natural desire to learn and a natural way of acquiring
knowledge at varying stages of life. Dr. Montessori
brought about change by introducing new principles
into existing thought.
Other elements of genius are creativity, flexibility
of thought and fluent production of ideas. Creative
thinkers are tolerant of ambiguity and the unknown,
and they are willing to take intellectual risk to see
what worlds exist beyond the looking glass of
established thought. They are not afraid of failure
because they understand that not all experiments
are successful.
In Montessori, a child who allows a plate to slip
through her hands and watches it break when it
crashes to the floor learns a great deal from that
experience. She has learned the importance of
concentrating on a task, she has learned that china
plates must be cared for, and she has learned,
experimentally, an important law of physics –
“For every action, there is a reaction.” Because
the breaking of the plate is treating as a learning
Unfortunately for many, although science has validated
her methods, not every school is a Montessori school.
Many schools continue to be run like factories – with
loud bells or buzzers marking time for students to
turn off one learning channel, move to another
environment where a different learning channel is
expected to be turned on, and to receive information
that is poured, rather than discovered and shared.
Madison Montessori Academy
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The Architect Of Montessori
observed a simple wine press. Intuitively, he viewed
it from another perspective, and with only a few
modifications, the first printing press was born.
Gutenberg was not a Montessori student, but he
learned like one. He taught himself to view the
world that surrounds him with an open mind and a
willingness to explore.
experience, rather than an act that generates
punishment, she also learns that a failed task can
be a learning experience from which one can benefit
rather than a disaster with which one must be
burdened. This is how the mind becomes “prepared.”
Experimental discoveries that reinforce creativity and
flexibility of thought while reducing fear of failure are
how minds are prepared and are opened to new ideas.
It is from these small beginnings – a broken plate,
a finger painting that does not look like the vision
the young artist had or a failed experiment in the
laboratory – that minds are open to allow free-flowing
thoughts and new experiences. Your child does not
have to invent plastic wrap or found a software
company to exhibit genius. As a Montessori child,
he will exhibit genius by a lifelong love of learning
and how he lives his life.
In Montessori schools, teachers, the office staff and
everyone who comes in contact with the student work
hard to exhibit the Montessori sense of values to help
prepare the minds of our students. That is why your
Montessori student exhibits genius in his or her own
way, and is continuously encouraged to discover the
genius within. University professors tell us time and
time again that Montessori students, because they
have been responsible for their own work, because of
their ethics, ability to resolve differences and their
love of learning are usually better prepared for the
university environment that students who have had
their sense of responsibility “poured into them.”
Although we have seen that IQ cannot define genius,
it can be identified by an emotional intelligence
quotient or EQ. EQ can be developed, and as it
develops it helps open the mind to greater complexity
of thinking, a more holistic form of thinking, and an
ability to weigh multiple perspectives. Einstein said
many times that he did not invent any of his major
ideas through logic: he came up with them through
the use of imagination and intuition. Then, once he
came to a conclusion, he, of course, had to justify his
conclusions to the scientific community by a logical
demonstration of mathematics.
Because you have selected Montessori for your child,
you too are a genius.
Judith Cunningham has been on the board of directors
of the American Montessori Society and, since 2003,
has been the head of North America’s largest Montessori
school, the Toronto Montessori School. She is also vice
president and a director of the Canadian Association
of Montessori Administrators.
Copyright M:
As Newton watched the apple fall from the tree,
he viewed a sight that millions before him had seen.
By witnessing this everyday occurrence through the
lens of his unique perspective, Newton knew there
must be a force that caused the apple to fall to the
ground, rather than float upward into the sky or hover
while separated from the branch. Understanding the
logic of his perspective was easy: providing it to the
satisfaction of others was much more difficult.
Another example of EQ is Gutenberg’s invention of
moveable type. Gutenberg wanted to produce bibles
in quantity long before anyone ever thought of mass
production. He experimented with various printing
ideas, each one leading to failure. Then one day, he
The Magazine for Montessori Families. Reprint by permission.
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Madison Montessori Academy
The Genius Of Montessori
Maria Montessori A Woman
Ahead Of Her Time
made time to support various social reform movements
including the women’s suffrage movement, peace
efforts and child labor-law reform. Montessori became
well known throughout Europe, which contributed
to the publicity that surrounded her schools.
By Tim Seldin
Maria Montessori is as contriversial a figure in
education today as she was half a century ago.
Alternately heralded as the century’s leading advocate
for early childhood education or dismissed as outdated
and irrelevant, her research and the studies that she
inspired helped change the course of education.
In 1901 Montessori was appointed director of new
orthophrenic school in Rome, formerly used as an
asylum for “deficient and insane” children. Montessori
initiated a wave of reform in a system that formerly
had served merely to confine mentally handicapped
youngsters into empty rooms. Recognizing her
patient’s need for stimulation, purposeful activity and
self esteem, Montessori insisted that the staff speak
to the inmates with the highest respect. She set up a
program to teach her young charges how to care for
themselves and their environment. At the same time,
she began a meticulous study of all research previously
done on the education of the mentally handicapped.
Many aspects of modern education have been adapted
from Montessori’s theories. She is credited with the
development of the open classroom, individualized
education, manipulative learning materials, teaching
toys and programmed instruction. Those who studied
under her went on to make their own contributions to
child psychology and include Anna Freud, Jean Piaget,
Alfred Adler and Erik Erikson. Only in the last 35
years have parents and educators in North America
begun to recognize the consistency between the
Montessori approach and what research teaches us
about the way children learn.
Her studies led Montessori to the work of two
almost forgotten French Physicians of the 18th
and 19th centuries: Jean Itard and Edouard
Seguin. Itard is most famous for his work with
the “Wild Boy of Aveyron.” Itard hoped from this
study to shed some light on the age old debate about
what proportion of human intelligence and personality
is hereditary and what proportion stems from learned
behavior, which led Itard to postulate the existence
of developmental periods in normal human growth.
During these “sensitive periods”, a child must
experience stimulation or grow up forever lacking
adult skills and intellectual concepts that he missed
at the stage when they can be readily learned!
Although Itard’s efforts to teach the wild boy were
barely successful, he followed a methodical approach,
in designing the process, arguing that all education
would benefit from the use of careful observation
and experimentation. This idea had tremendous
appeal to the scientifically trained Montessori and
later became the cornerstone of her method. From
Edouard Seguin, Montessori drew further
confirmation of Itard’s work, along with a far
more specific and organized system for applying
it to the everyday education of the handicapped.
Maria Montessori was in many ways a women ahead
of her time. She was born in 1870 in Ancona, Italy,
to an educated but non-affluent family. Against the
considerable opposition of her father and teachers,
Montessori pursued a scientific education and became
the first physician in Italy.
As a practicing physician, she was a scientist, not a
teacher. It is ironic that she became infamous for
her contributions in a field that she rejected as the
traditional refuge for women. The Montessori
“Method” evolved almost by accident from a small
experiment. Her genius was not in her teaching
ability, but rather her recognition of the importance
of what she stumbled upon.
As a physician, Montessori specialized in pediatrics.
Through her work in free clinics and private practice,
she came into frequent contact with children and
families of the working class and poor. These
experiences reinforced her humanistic ideals, and she
Madison Montessori Academy
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The Genius Of Montessori
From these two predecessors, Montessori took the
idea of a scientific approach to education, based on
observation and experimentation. She pursued her
work with the careful training and objectivity of the
biologist studying the natural behavior of an animal
in the forest. In her studies of children, she began to
get a sense of who they really were and what methods
worked best. Her success was given widespread notice
when, two years after she began, many of Montessori
“deficient” adolescents were
able to pass the standard sixth
grade tests of the
Italian public schools.
Acclaimed throughout
Europe for the “miracle,”
Montessori responded by suggesting that her results proved
only that public schools should
be able to get dramatically
better results with normal
children.
The children themselves were typical of extreme
inner-city poverty conditions. They entered school
the first day crying and pushing, exhibiting generally
aggressive and impatient behavior. Montessori, not
knowing whether her experiment would work
under such conditions, began by teaching the older
children to help out with the everyday tasks
that needed to be done. She also introduced the
manipulative perceptual puzzles that she had used
with the retarded. The results
surprised her, for unlike her retarded children who had to be
prodded to use the materials;
these little ones were drawn
to the work she introduced.
Children who had wandered
aimlessly the week before
began to settle down to long
periods of constructive activity.
They were fascinated with the
puzzles and perceptual training
devices. But, to Montessori’s
amazement, children three
and four years old took the
greatest delight in learning
practical everyday living
skills that reinforced their
independence and
self-respect. Each day they
begged her to show them
more, even applauding with
delight when Montessori
taught them the correct use of
a handkerchief. Soon the older
children were taking care of
the school, assisting their teacher with the preparation
and serving of meals and the maintenance of a spotless environment. Their behavior as a group changed
dramatically from street
urchins running wild to models of grace and courtesy.
It was little wonder that the press found such a human
interest story appealing and promptly broadcast it to
the world.
Unfortunately, the Italian
Ministry of Education did
not welcome this idea, and
she was denied access to
school-aged children. In 1907
Montessori jumped at the
chance to coordinate a series
of day-care centers for
working-class children who
were too young to attend
public school. These
“Children’s Houses” were
located in the worst slum
district in Rome, and the
conditions Montessori faced were appalling.
Her first class consisted of 60 children from ages
two through five years of age, taught by one untrained
caregiver. The children remained at the centre from
dawn to dusk while their parents worked. They had
to be fed two meals a day, bathed regularly and given
medical care.
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Madison Montessori Academy
Curriculum
All programs offered at Madison Montessori include the following in the curriculum…
Practical Life
Practical Life develops independence and self confidence while enhancing the child’s hand-eye coordination and fine motor skills. The time the child spends on mastering
these everyday tasks, such as caring for self and the environment will help them develop
concentration and lengthier attention spans.
Sensorial
With specialized Montessori materials, the sensorial part of the classroom focuses on education through the five senses, which is the best way for young children to learn.
They learn to recognize similarities and differences thereby enhancing their mental
development.
Language
Mathematics
Culture
Although Language is used throughout the curriculum this area helps children develop vocabulary and polite manners. Montessori Language education is based on phonetic
science where they learn the sounds of the letter symbols; this allows them to begin
reading at a very young age. The Montessori materials are made to ease this learning
process and children are able to write independently from an early age.
Learning mathematics comes easily to children who work with the Montessori materials
which graphically show what is taking place in a given process. The children are able to
actually see what is taking place making the abstract concepts clear and concrete.
This part of the curriculum includes History, Geography, Science and Art. The children
work with specially designed maps and they begin to learn the names of the continents
and countries. Physical geography begins with the formation of the earth, the oceans
and different land forms and natural resources. Montessori science includes a sound
introduction to botany and zoology. Students begin to understand the relationship
between living things and their physical environment. The emphasis of our art program
is creative freedom. Children are encouraged to express themselves artistically through various art mediums such as paint, group collage and clay.
Madison Montessori Academy
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Testimonials
“Melissa and I are beyond thrilled at the progress Brandon has made over his time with MMA. He has
transformed from a little boy who seemed to feel his Mom and Dad were all he needed or wanted in this
world, to a little explorer, always anxious to try new things or socialize with new people. Every member of
our extended family is absolutely amazed with the change in Brandon’s social skills and fascinated at the level
of his general motor skills. The groups of individuals on your staff have been wonderful, and have treated us
better than we ever expected. Brandon runs to the door in the morning after we get his shoes on, as he is
bursting to get there for another day, and always returns with a new trick or dance to show off at home.
From the bottom of our hearts, please extend a most sincere thank you to your entire team for the love
and attention they have afforded him. We cannot wait to see what he
learns next”. — Rob & Melissa Taylor
“We really enjoy the number of activities that the infant program offers. Anna always seems happy to be
dropped off in the mornings. We like the bright atmosphere (windows, colors, etc). It is a great system with
the log books for feedback on Anna’s day”. — Pia Gamberg
“We were so pleased to find an Infant program we felt comfortable with for our twins. Mommy found it hard
to leave them when they were 14 months old, even part time. To find a friendly staff and faculty we trusted was
a huge relief.”
“Last summer was full of a variety of activities. We especially enjoyed taking part in the swimming lessons and
the field trip to the Museum of Agriculture. We look forward to more fun in the summertime. Another feature
at the school that is important to us is the fresh food and healthy snacks they are offered. Kya thrives with the
focus on independence (“I can do it myself, Daddy!”). She is growing daily, in many ways. Spencer loves circle
time, storytime, and playing with his classmates. Both of our children are eager to go to school every day and
always come home happy. What a delight! Thank-you MMA!” — Andrea and Michael
“Landyn has been attending Madison Montessori Academy since the end of November 2009. We have
noticed a huge change in everything that he does... All for the positive! We can’t express our gratitude
enough, words just can’t say it all. Having his birthday at the end of December, we are confident that by
the time j.k rolls around, Landyn will be more than ready.”
“Rumours around town was that it was very pricey. We are SO glad that we decided to find out for ourselves..
don’t believe everything you hear!!!! We can not imagine a better place for our child to be all day. With both
of us working in Ottawa, we go to work knowing that our son is in very good hands. To trust enough to leave
your child in someone else’s care, that’s tough for most parents. I’m actually jealous, that I don’t get to be there
all day too.. The positive energy the staff gives, the straight answers given when asked a question, nothing is
hidden..What more can anyone ask for.”
“-Landyn asks to go to “school” everyday, including the weekends. He enjoys playing with his new found
friends, learning and trying out new skills. He is eager to come home to show/tell us what he has learned
that day. He’s even learning to speak french. Plus nutrional meals and snacks everyday.” (continued)
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Madison Montessori Academy
Testimonials
“-Miss Jessica called one evening from her home, to see how Landyn was feeling, as he came home sick
that day. That phone call meant everything! It shows, that the staff aren’t there just for a job, but that they
truly do care about our child’s well being, even after hours. Another time, it was a rough morning dropoff,
and Mr. Dan called to give an update that Landyn was doing fine, it was just a tantrum.This shows
compassion and that it isn’t just a job.”
“-At Madison Montessori the doors are locked, parents need a special card to get in. The fact that they took
interest in investing in such a system, shows that the security of every child enrolled there is a main concern.”
— Shawn, Charmaine and Landyn Carnegie
Upon our family moving to the Kemptville area from Ottawa we were a little apprehensive about the quality of
care that our children would receive. Our daughter Linden had been enrolled in several facilities in the Ottawa
area before we moved. Although she was progressing along nicely both socially and academically, something
was always missing from the day care centers she attended. We wanted to find the perfect place for our son Rye
to begin his journey of early childhood education. After interviewing over a dozen home-based daycares we
found Madison Montessori Academy online and booked an appointment right away.
After meeting with the headmistress April and receiving a tour of the facility we were impressed immediately.
As a parent, there is something to be said about that ‘good feeling’ you have about something and even more
weight is put to that feeling when regarding your children and their childcare. So on a hunch, we registered our
son right away and have never looked back. Rye started his journey in the infant program where he was surrounded by devoted caregivers that understood the significance of balancing love and nourishment with educational growth. The sincerity in the caregiver’s faces and voices on a daily basis for both drop off and pick up
was enough to ease our nerves and positively reinforce the decision that we made to send our little boy to MMA
at such a young age. He has since graduated to the toddler program and has continued to develop into the well
behaved little man like we knew he could.
We then decided to enroll our eldest child into the summer program before heading off to Junior Kindergarten.
Once she joined the family at MMA she has continued to blossom into a delightfully smart little girl that we
are extremely proud of. Linden has since graduated from MMA where she was provided with an early childhood toolkit of manners, social skills and quality education, which parallels our family’s philosophy and beliefs.
Still after her graduation, Linden loves attending the before and after school program MMA offers were she
safely gets on and off the bus every morning and afternoon.
Your academy should pride itself on offering the Kemptville area an elite professional childcare service while
keeping costs to a minimum. We would like to genuinely Thank You for the enhanced progression of our children Linden and Rye. We will forever be grateful knowing that Madison Montessori Academy provided the
best childcare experience for our children. They will continue to benefit from the developmental and social skills
established as well as cherish the friendships made for years to come. Thank you. Thank you. Thank you.
— The Little-Mansell’s
Madison Montessori Academy
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Rotating three Week Menu
Week 1
Week 2
Monday
Homemade Chili
Monday
Turkey & Cheese Sandwiches
Tuesday
Sliders and Potatoes
Tuesday
Meatballs and Veggies
Wednesday
Homemade Chicken Noodle Soup
Wednesday
Grilled Ham & Cheese Sandwiches
Thursday
Corndogs and Fries
Thursday
Homemade Stew
Friday
Homemade Goulash
Friday
Beans andWeiners
Week 3
Monday
Taco Salad
Tuesday
Hammy Scalloped Potatoes
Wednesday
Homemade Spaghetti
Thursday
ChickenNuggets & Potatoes
Friday
Smoked Sausage Gumbo
At Madison Montessori Academy we understand that all children are diffrent in the way they learn,
some react better to visual stimulation while others need to be more hands on... One thing all children have
in common is that on a full tummy they absorb more, retain more and have a much better attention span.
For that reason we buy all of our fresh produce and groceries locally the day it will be
prepared and, cook all of our hearty nutritional meals at the school in our own kitchen!
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Madison Montessori Academy
Application for Admission
Student Information
Last Name_____________________ First Name_____________________ Middle Name_________________
Date of Birth___________________
Male
Female First Language________________
Address _________________________________________________________________________________
(Street Name)(Apartment Number)
_________________________________________________________________________________________
(City)(Province)(Postal Code)
Family Information
Mother
Father
Last Name___________________________________
Last Name___________________________________
First Name__________________________________
First Name __________________________________
Address_____________________________________
Address _____________________________________
Home Phone_________________________________
Home Phone ________________________________ Work Phone Ext ____________________________
Work Phone Ext _____________________________
Cell Phone__________________________________
Cell Phone __________________________________ Email_______________________________________
Email ______________________________________
Sibling Information
Name_________________________________
Male
Female
Date of Birth___________________
Name_________________________________
Male
Female
Date of Birth___________________
Name_________________________________
Male
Female
Date of Birth___________________
Name_________________________________
Male
Female
Date of Birth___________________
Madison Montessori Academy
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(d/m/y)
(d/m/y)
(d/m/y)
(d/m/y)
Application for Admission
Medical Information
Doctor’s Name_______________________________________________ Phone_________________________
Allergies____________________________________________________ Other________________________
Health History ____________________________________________________________________________
_________________________________________________________________________________________
Immunization Record Given
Yes
No
Is there any reason to be exempt from Immunization?
Yes
No
If “Yes”, then an exemption form must be completed and attached.
Special Conditions: _________________________________________________________________________
_________________________________________________________________________________________
Emergency Contact #1 (other than parent)
Emergency Contact #2 (other than parent)
Name _____________________________________
Name ________________________________________
Relationship _______________________________
Relationship __________________________________
Home Phone _______________________________
Home Phone __________________________________
Work Phone _______________________________
Work Phone __________________________________
Cell Phone ________________________________
Cell Phone: ___________________________________
Drop off/Pick up Information (Please indicate other than parents)
Name ____________________________________
Name_________________________________________
Relationship _______________________________
Relationship___________________________________
Phone ____________________________________
Phone _______________________________________
Cell Phone ________________________________
Cell Phone ___________________________________
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Madison Montessori Academy
Application for Admission
Program Requested
Infant Program
Part Time
Full Time
Schedule ‘A’
or
Schedule ‘B’
Toddler Program
Part Time
Full Time
Schedule ‘A’
or
Schedule ‘B’
Casa Program
Part Time
Full Time
Schedule ‘A’
or
Schedule ‘B’
Before & After Care____________________________
Start Date___________________________________
Authorization
I hereby grant permission for the Program Staff of the Child Care Program to take whatever steps necessary
to obtain emergency medical attention in the event that I (parent/legal guardian) cannot be reached. It is
also understood that I (parent/legal guardian) shall assume responsibility for any cost incurred.
I hereby grant permission for my child to leave the licensed premises under the supervision of a staff
member for field trips, community walks, etc. I understand that dated, time-limited specific forms will
be issued for each field trip.
I hereby grant permission for my child to use the play equipment and participate in all of the activities
of their program at Madison Montessori Academy.
Signatures
Parent/Guardian______________________________________________
Date ________________________
Parent/Guardian______________________________________________
Date________________________
Madison Montessori Academy
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Emergency Record For classroom
Student’s Information
Child’s Name_________________________________
Date of Birth_________________________________
First Contact:______________________________________________________________________________
Parent’s Information
Mother’s Name________________________________
Phone(H)___________ (W)___________
Address: Home____________________________________________________________________________
Address: Work_____________________________________________________________________________
Cell Phone:___________________________________
Email Address:_______________________________
Father’s Name_________________________________
Phone(H)___________ (W)___________
Address: Home____________________________________________________________________________
Address: Work_____________________________________________________________________________
Cell Phone:___________________________________
Emergency Contact
Email Address:_______________________________
1. Name______________________________________
Phone (H)__________________________________
Relationship_________________________________
2.Name______________________________________
Phone (H)__________________________________
Relationship_________________________________
(W)________________________________________
(W)________________________________________
Pick-up Information
1. Name______________________________________
Phone (H)__________________________________
Relationship_________________________________
2.Name______________________________________
Phone (H)__________________________________
Relationship_________________________________
(W)________________________________________
(W)________________________________________
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Madison Montessori Academy
Physician
Name________________________________________
Phone______________________________________
Address___________________________________________________________________________________
Allergies &/or Special Medical Information:
_________________________________________________________________________________________
_________________________________________________________________________________________
Symptoms of ill health
Date
Madison Montessori Academy
Symptoms (detailed)
Parent Contacted
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Staff
Student Questionnaire
Student Information
*Please note that all information given on this form will remain confidential
Student Name_________________________________
Date of Birth_________________________________
(d/m/y)
What form of child care has your child had previously? Please explain._________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Does your child nap during the day? If so, at what time and for how long?______________________________
_________________________________________________________________________________________
What signs of fatigue does your child exhibit?_____________________________________________________
_________________________________________________________________________________________
Does your child have any dietary restrictions? If so, explain.__________________________________________
_________________________________________________________________________________________
What signs of hunger does your child exhibit?_____________________________________________________
_________________________________________________________________________________________
Has your child had group play experiences? If so, where and how often?________________________________
_________________________________________________________________________________________
What are your child’s favourite indoor and outdoor activities?________________________________________
_________________________________________________________________________________________
Does your child experience any separation anxiety? ________________________________________________
_________________________________________________________________________________________
Does your child dress him or herself at home?_____________________________________________________
_________________________________________________________________________________________
How do you discipline your child?______________________________________________________________
_________________________________________________________________________________________
Is your child left or right handed?_______________________________________________________________
Is your child toilet trained?____________________________________________________________________
How would you describe your child’s personality?__________________________________________________
_________________________________________________________________________________________
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Madison Montessori Academy
Student Questionnaire
What areas would you like to see your child’s potential more fully developed?
What past illnesses has your child had? At what age?
Chicken Pox____________ age
Scarlet Fever____________ age
Mumps________________ age Measles________________ age
Hepatitis_______________ age
Any complications?__________________________________________________________________________
_________________________________________________________________________________________
Has your child had any serious accidents? Explain._________________________________________________
_________________________________________________________________________________________
Does your child have allergies? If so, to what and how do they normally manifest themselves?_______________
_________________________________________________________________________________________
_________________________________________________________________________________________
Does your child have frequent: Tonsilitis
Ear Aches
Stomach Aches
Nose Bleeds
Colds
Explain___________________________________________________________________________________
_________________________________________________________________________________________
Does your child have any learning, behavioural or developmental needs?________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Any other comments that you feel will assist us in the care of your child?_______________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Please provide us the names and birthdays of parents, grandparents, siblings and other household members
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Madison Montessori Academy
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Release Form for Media Recording
I, the undersigned, do hereby grant or deny permission Madison Montessori Academy to use the
image of my child_____________________________________, as marked by my selection(s) below.
Such use includes the display, distribution, publication, transmission, or otherwise use of photographs,
images, and/or video taken of my child for use in materials that include, but may not be limited to,
printed materials such as brochures and newsletters, videos, and digital images such as those on the
Madison Montessori Academy Web site.
Deny permission to use my child’s image at all.
Grant permission to use my child’s image in the following ways (mark all that apply):
Limited usage: I want my child’s image used within the Madison Montessori Academy
setting only (not in the larger community).
Limited usage: I want my child’s image used for educational materials only (not marketing).
This could be either within Madison Montessori Academy or in the larger community.
One example of this could be videos in parent education classes.
Limited usage: I want my child’s image used on printed materials only (no digital or video use).
Unrestricted usage: I give unrestricted permission for my child’s image to be used in print, video,
and digital media. I agree that these images may be used by Madison Montessori Academy for a variety
of purposes and that these images may be used without further notifying me. I do understand that the
child’s last name will not be used in conjunction with any video or digital images.
Parent/guardian signature_______________________________ Date_____________________________
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Madison Montessori Academy
Release Form
Leeds, Grenville and Lanark District Health Unit
Department of Clinical Services
Daycare Registration Form
Please return form to:
Brockville Office – 458 Laurier Blvd, Brockville, ON K6V 7A3 or
Fax to 613 345-7038
For Inquiries call 1800-660-5853 or 613 345-5685 ext. 2268 or 2364
CHILD INFORMATION:
SURNAME: __________________________GIVEN NAME:_____________________SEX: ____________
BIRTH DATE: _____ - _____ - _____
Y
M
D
OHCN: _________ - __________ - __________
(Ontario Health Card Number)
DAY CARE FACILITY: ___________________________________________________________________
PREVIOUS NURSERY OR DAYCARE ATTENDED IN LGL AREA: ____________________________
PARENT/GUARDIAN INFORMATION:
SURNAME: __________________________________
FIRST NAME:___________________________
RELATION TO CHILD: ______________
STREET ADDRESS: ____________________________________________________________________
PO BOX: ________________________________
APT #: ________________________________
TOWN/CITY: _____________________________
POSTAL CODE: __________________________
HOME PHONE: ___________________________
WORK PHONE: __________________________
DOCTOR & TELEPHONE NUMBER: ________________________________________________________
PLEASE COMPLETE BOTH BOXES AND ENSURE THE CHILD’S NAME AND
DAYCARE FACILITY ARE ON THE PHOTOCOPY OF THE IMMUNIZATION RECORD
YOU ATTACH TO THIS FORM
Collection of this information is authorized under the Immunization of School Pupils Act, 1990. Questions regarding collection of this information may be directed to Clinical
Services Department of The Leeds, Grenville and Lanark District Health Unit, 458 Laurier Blvd., Brockville, ON, K6V 7A3, telephone (613) 345-5685.
DCS-10-08-VPD-057
Madison Montessori Academy
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Tuition Fees
Programs
Tuition/month
Infant Full Time
Infant Part Time
$1100.00
$660.00
Toddler Full Time
Toddler Part Time
$895.00
$537.00
Casa Full Time
Casa Part Time
$895.00
$537.00
Before & After Care
(7:00-9:00 & 3:30-6:00)
Before & After Care Extra Care Package
(7:00-9:00 & 3:30-6:00)
Includes: P.D. Days, Snow Days, Extra days
during Christmas Break and March Break
$280.00
$360.00
Part Time Options
Schedule A - Mondays, Wednesdays and Alternate Fridays
Schedule B - Tuesdays, Thursdays and Alternate Fridays
Subsidized Childcare
Madison Montessori Academy offers subsidized spaces approved
through the United Counties of Leeds and Grenville.
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Madison Montessori Academy