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The Peace Rose Montessori School

Summer Camp Enrollment Contract

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20%

Summer Camp 2025

The Peace Rose Montessori summer camp offers our young learners various fun-filled adventures. The program incorporates music, arts and crafts, movement, and outdoor activities including water play. Each week our campers will delve into different topics that will fascinate young minds and feed their curiosity to learn. Our summer camp schedule is on a weekly basis and allows parents to choose the schedule they require. Our campers have a great time exploring in the classroom and playing in our beautiful outdoor playground. Activities will be centered on the following themes with some special events booked throughout the summer.

Please note: You would have to complete State of New Jersey Health Universal Child Health Record prior to the first day of attendance. If your child is a current student, an updated form is not required unless the date of the last physical has expired.

Click here to download Universal Child Record

Peace Rose Handbook School Policy

Please ensure that you download and read the policies from the Parent Handbook before filling out the Enrollment form.

Click here to download Parent Handbook
ENROLLMENT AGREEMENT

Completing this enrollment contract does not guarantee placement. The director will guide you with next steps such as deposit and school visit.
Consent
I hereby authorize my child/children to attend Peace Rose Montessori School Summer Camp (June-August 2025)
Child’s Name*
Child’s First Name Child’s Last Name
Date of Birth (MM/DD/YYYY)*
Date Format: MM slash DD slash YYYY
Primary Home Address*
Street Address City State / Province / Region ZIP / Postal Code
Primary Contact Phone*
Primary Email Address*
FAMILY INFORMATION
Parent/Guardian #1 Name*
First Last
Relationship to child*
Employer*
If not applicable, write n/a or none.
Occupation*
If not applicable, write n/a or none.
Work Phone
Cell Phone*
Cell Phone Carrier*
- AT&T
- VERIZON
- T-MOBILE
- GGOGLE Fi
- SPRINT
- METRO PCS
- ALLTEL
- H2O WIRELESS
- MINT MOBILE
- BOOST MOBILE
- STRAIGHT TALK
- VIRGIN XFINITY
Email*
Address
Same as primary address

Street Address City State / Province / Region ZIP / Postal Code
Add second parent?*
- Yes
- No
Parent/Guardian #2 Name*
First Last
Relationship to child*
Employer*
If not applicable, write n/a or none.
Occupation*
If not applicable, write n/a or none.
Work Phone
Cell Phone*
Cell Phone Carrier*
- AT&T
- VERIZON
- T-MOBILE
- GGOGLE Fi
- SPRINT
- METRO PCS
- ALLTEL
- H2O WIRELESS
- MINT MOBILE
- BOOST MOBILE
- STRAIGHT TALK
- VIRGIN XFINITY
Email*
Address*
Same as primary address

Street Address City State / Province / Region ZIP / Postal Code
Child Lives with:*
- Both Parents
- Mother
- Father

PICK-UP APPROVAL

In addition to emergency contacts listed above, please list any names, phone numbers, and relationships of persons authorized to pick up and transport your child from school.
In addition to emergency contacts listed above, please list any names, phone numbers, and relationships of persons authorized to pick up and transport your child from school.
Check the box beside the statement:*
I understand that if my child is to be transported by anyone other than the above list, I must send a written permission slip to camp and inform the teachers or Director verbally.
Name*
Phone*
Relationship*
Name*
Phone*
Relationship*

MEDICAL ATTENTION AUTHORIZATION

In case of medical needs and if the parents/guardians cannot be reached, school authorities are authorized to take my child/children (listed below) to a doctor or hospital and secure treatment as necessary. 911 will be called in any serious emergencies.
In case of medical needs and if the parents/guardians cannot be reached, school authorities are authorized to take my child/children (listed below) to a doctor or hospital and secure treatment as necessary. 911 will be called in any serious emergencies.
Child’s Name*
Hospital Preference*
Allergies*
If not applicable, write n/a or none.
Other Conditions*
If not applicable, write n/a or none.
Local Physician Name*
Local Physician Number*
Parent Name*
Parent Signature*
Date*
Date Format: MM slash DD slash YYYY

SUMMER CAMP TUITION

Registration Fee $75, 1 week deposit due to enroll with completed enrollment form.

Weeks 1-4 Tuition due by June 18th/Weeks 5-8 Due July 25th.

Summer Camp Themes
Please specify your daily schedule:

Important note: Our regular full day is from 9am to 3pm. Please be sure to drop your child off daily by 9am if they are not signed up for Before Care. Pick up for half day is 12:00, half day campers do not eat lunch at school. Full Day dismissal is 3pm unless your child is signed up for after care. Please pack a snack and lunch daily.
Please select program:*
- Nido (0 to 18 mo)
- Toddler (18mo to 3)
- Primary (3 to 6)
Please specify your daily schedule:*
- 5 Half Days - (8:45am to 11:45am)
- 5 Full Days - (8:45am to 2:45pm)
- 3 Half Days - (8:45am to 11:45am)
- 3 Full Days - (8:45am to 2:45pm)
Please select which weeks you are enrolling your child:*
- Week 1: June 30 to July 3 (discount for July 4)
- Week 2: July 7 to July 11
- Week 3: July 14 to July 18
- Week 4: July 21 to July 25
- Week 5: July 28 to Aug 1
- Week 6: Aug 4 to Aug 8
- Week 7: Aug 11 to Aug 15
- Week 8: Aug 18 to Aug 22
Extended Care needed?*
- Yes
- No
Before Care*
- Nido (0 to 18mo) (8:00am to 8:45am)
- Toddler (18mo to 3) (8:00am to 8:45am)
- Primary (3 to 6) (8:00am to 8:45am)
- NA
After Care*
- Nido (0 to 18mo) (2:45pm to 4:00pm)
- Toddler (18mo to 3) (2:45pm to 4:00pm)
- Primary (3 to 6) (2:45pm to 5:00pm)
- NA

STATE OF NEW JERSEY HEALTH HISTORY & UNIVERSAL HEALTH RECORD

Please complete State of New Jersey Health Universal Child Health Record prior to the first day of attendance. If your child has one from the school year, an updated one for camp is not required. (Unless physical date has expired.)
Upload New Jersey Health Universal Child Health Record
If you have a completed State of New Jersey Health Universal Child Health Record. Please upload the file through the file upload option below:

If it is not completed, you would have to complete State of New Jersey Health Universal Child Health Record prior to the first day of attendance.

If your child is a current student, an updated form is not required unless the date of the last physical has expired.
Drop files here or
PHOTO RELEASE
Peace Rose Montessori may use photos of your child in school promotions, advertising, social media posts, or the school website.
Peace Rose Montessori may use photos of your child in school promotions, advertising, social media posts, or the school website.
Unless you indicate otherwise Peace Rose Montessori may use photos of your child in school promotions, advertising or the school website. I am pleased to grant to the Peace Rose Montessori School the right to use my son's or daughter's name, voice and likeness in the Peace Rose Montessori School's programs, publicity, and promotional materials, and in any broadcast or transmission in any social media, including newspapers, magazines, television, and the Internet.*
- Yes
- No
Parent Signature*
Date*
Date Format: MM slash DD slash YYYY
ACKNOWLEDGEMENT OF RISK
Consent*
The School is taking extensive measures to ensure a safe environment for all students and staff, in accordance with state and federal guidelines. However, some risk of illness remains in a summer learning environment. As part of the 2025 summer program agreement, parents must acknowledge and voluntarily accept these risks, waiving any future claims related to illnesses. I understand these risks, and if my child is ill, he/she must remain home until at least 24 hours after symptoms and fever subside, without medication.
Parent Signature*
Date*
Date Format: MM slash DD slash YYYY
Universal health form
Upload universal health form
Drop files here or
Peace Rose Handbook School Policy Confirmation
Parent Notification:
In case of injury or illness, we will always contact parents first, followed by emergency contacts via phone call. For minor incidents, please indicate if a text notification is ok or if you prefer a phone call. Again, this is for non-urgent matters. In an urgent matter or emergency, parents will be contacted via phone and if not reached, all emergency contacts will be called and then texts and emails will be sent until we reach someone.
We give permission for text notification in NON-URGENT matters*
Please check off each item and sign below:*
- I have read the Parent Handbook regarding all school policies
- Information to Parents
- Expulsion Policy
- Policy on Discipline
- Policy on Management of Communicable Diseases
- Child Release/Failure to Pick up Child Policy
- Policy on Release of Children
- Policy on the Use of Technology and Social Media
Check the box beside the statement:*
- I have received a copy of The Peace Rose Montessori Handbook which includes the information/policies listed above.
Parent Signature*
Date*
Date Format: MM slash DD slash YYYY

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