Rooted Life Montessori Elementary Education

Rooted Life Montessori Summer Camp Application


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Please select one of the following options.


Summer Camp Information

Please choose your child's age group.

Are you interested in our before school care program?


Emergency Contact Information

List telephone numbers below where parents or guardians my be reached while the child will be in care.

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Guardian Release Information

I hereby authorize Rooted Life Montessori to allow my child to leave the Rooted Life Montessori facility ONLY with the following persons:

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*Click to add or remove guardians.


First Aid Release

Rooted Life Montessori does not dispense medications, either prescription or over the counter. Our First Aid Protocol for minor ailments is indicated in the chart that follows: Please choose which option you would like by initialing the choice of treatment. All oils are diluted in water and sprayed topically.

Ailment

  • Sun Burn

  • Bug Repellent

  • Bee Sting / Ant Bite

  • Cut / Scrape / Bruise

  • Seasonal Allergies

  • Sore Stomach

DoTerra Oil

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Other Options

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First Aid Consent

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Medical Information

Please list any allergies your child has.

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Please list any existing ailments or illnesses your child has.

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Please list any previous injuries or hospitalizations your child has had.

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Conditions

By checking this box you acknowledge that you understand the time's that our summer camp operates.

Please choose your payment method

By checking this box you acknowledge that you understand that no spots will be reserved until all camp fees and forms are submitted.