DUPAGE MONTESSORI SCHOOL 1111 E. Warrenville Road Naperville, IL 60563

(630)369-6899 Fax: (630)369-7306

Dear Parents,

We would like to welcome our new and returning students to DuPage Montessori School for the 2019-2020 school year. The first day of school is Thursday, August 15th. Access to all forms, handbooks, lunch menus, map of the classrooms, school directory, statements, and payment options is available online. Check your e-mail daily or use your parent login and password at www.dupageschool.org for updates.

Parent Orientation Nights Friday, August 16th, 4:30pm - Toddler Classes Tuesday, August 20th, 7:00pm - Upper Elementary Wednesday, August 21st, 6:00pm - Ms. Lynn Wednesday, August 21st, 6:30pm - Ms. Maha Thursday, August 22nd, 6:00 pm - Lower Elementary Thursday, August 22nd, 7:00pm - Ms. Chris Friday, August 23rd, 7:00pm - Ms. Aileen & Ms. Nelly

All parents are asked to attend our Parent Orientation Nights where our teachers will explain the daily schedule, the main events of the year, and answer any questions. Childcare will be offered for these evenings at $5 per child. Parents are to sign-up prior to the evening. Please contact the office if you will need childcare by Tuesday, August 13th.

Forms and Fees All forms and fees are due by August 1st, which includes the Registration and Deposit Fees. August Tuition is due by August 15th. Tuition payments from September through May are due the 1st of each month. Please call the office if you have any questions.

The Emergency Contact and Medical forms must be returned to the school by August 1st. Medical forms are required by the State and County Health Departments for all new students entering school on August 1st. Students entering kindergarten and sixth grade will also need new or updated health forms.

Kindergarten, second grade, and sixth grade students are also required to have a dental examination. Kindergarten and new elementary students will need to have a comprehensive eye exam.

New elementary students should also have copies of their permanent files sent to DuPage Montessori prior to admission. Please arrange to have them mailed or e-mailed to the school before August 1st.

Naperville Information and Procedures Please review the attached Information and Procedures flyer for information about new arrival/dismissal procedures, field-trips, snacks, and more.

All parents are welcome to join our Parent Task Force. Our PTF organization is an integral part of our school community who help plan our family events and fundraising projects. More information will be coming with our events for the 2019- 2020 School Year.

We are looking forward to the new school year!

DuPage Montessori School (Naperville) - School Calendar 2019-2020

August15 First Day of SchoolTBA Toddler Orientation - Time and Day TBD by your teacher TBA Primary Parent Orientation - Time and Day TBD by your teacherTBA Parent Orientation 6 p.m. (Lower Elementary) 7:00 p.m. (Upper Elementary) 30 Ice Cream Social 6 p.m.

September 2 No School - Labor Day Holiday – No Childcare Available13 Spirit Day (students wear school t-shirt)

October25 October Fall Festival (games, food, and magician)

November22 Children’s Thanksgiving Celebration 25 No School - Parent/Teacher Conferences for all classrooms - No childcare available26 No School - Parent/Teacher Conferences for all classrooms - No childcare available27 - 29 No School - Thanksgiving Holiday – No Childcare Available

DecemberTBA Winter Celebrations 20 Last Day of School 23- 1/3 Winter Break No school on December 24, 25,31, and January 1st. -Childcare available if enough interest.

January 6 School Resumes20 School Closed - Dr. Martin Luther King Jr. Day – No Childcare Available22 Fall 2020 Current Student Registration Begins

February14 Children’s Celebration of the Heart (Valentine’s Day)17 No School - President’s Day – No Childcare Available

March26 No School - Parent/Teacher Conferences - No childcare available 27 No School - Parent/Teacher Conferences - No childcare available 30 - 4/3 Spring Break - Childcare available if enough interest

April 6 School Resumes 10 Summer Registration Begins

May21 Last Day of School-School Closes for all students at 11:30 am Graduation/Spring Celebration22 School Closed - No Childcare Available 25 No School - Memorial Day26 Summer School Begins

*Note: In the event that our school is closed due to extreme weather conditions, an email will be sent to all parents immediately. In addition, we will have an alert banner posted on our home page, and our school will be listed on the Emergency Closing Center website: http://www.emergencyclosingcenter.com

Drop-Off ProceduresDuPage Montessori opens at 7:30 am. Our Elementary Program starts at 8:15 am and our Toddler and Preschool Program starts at 8:30 am.

Toddler Students: Parents will bring their children directly into the school. Please park in the DMS designated spots along the playground and soccer field. Once inside the school, we will have assistants available to take your child to their classroom.

Preschool and Elementary Students: At 8:00 am, we will start our drop-off line for our elementary children. Preschool can begin to use the drop-off line at 8;15 am. If you need to drop-off your child earlier than the above times listed for your child’s program, please park your car and walk your child to the early arrival class. We ask that you do not go through parking spaces as a short cut, as we have had several fender benders last year due to this practice. This will ensure the safety of our children and parents. It is the parent’s responsibility to remove your child and their belongings from the car. Our assistants will then help guide the children into the school and to their classrooms. If your child is having difficulty leaving the car, please park in a parking space and physically bring your child into the school. Drop-off time ends at 8:30 am for all our programs. Our teachers will greet your child by their classroom door and help with outerwear and shoes if necessary.

Pick-Up ProceduresToddler Students: Parents will park in the DMS designated spots and come into the school to pick up their children. Please see the instructions and directory by the lobby phone to contact your child’s classroom.

Preschool and Elementary Students: Parent or authorized alternate guardian will need to park and come into the school for pick-up. Please see the instructions and directory by the lobby phone to contact your child’s classroom.

Late Pick-Up PolicyA late fee of $8.00 per hour is charged for time beyond the scheduled pick-up time. At 6:00 pm the school is closed. Parents are expected to adjust their work schedules accordingly for bad weather, traffic, and late meetings when choosing a pick-up time for their child. If you are not going to be at school by 6:00 pm, it is your responsibility to have someone who can pick-up your child by 6:00 pm.

Snacks: Toddler Snacks: All snacks and lunches are provided by the school per DCFS regulations and rules. If your toddler has a health food issue, a letter from your child’s pediatrician will be needed for you to bring in food for your child. Please remember we are a peanut/tree nut free facility.

Preschool Morning Snack: Parents will pack a healthy, peanut/tree nut-free snack for their child on a daily basis. We suggest fruit, veggies, or a healthy protein.

DuPage Montessori School Information and Procedures for Naperville Campus

2019-2020 School Year

DuPage Montessori School Information and Procedures for Naperville Campus

2019-2020 School Year

Preschool Afternoon Snack: Parents will now provide their child’s afternoon snack(s) based on the following:1. How long their child is in the after-school program. If the child is leaving at 3:00/4:00 pm

a fruit/vegetable would be an appropriate snack. 2. If your child is leaving at 5:00/6:00 pm, please pack two snacks for your child. A 3:00 pm

fruit/vegetable snack and a fiber/protein snack to be eaten at 5:00 pm. 3. If your child is going through a growth spurt, please adjust the afternoon snacks

accordingly.4. Please remember to label all snacks for your child and put in your child’s lunchbox.

Elementary Snacks: Lower and Upper Elementary students bring their own snack for both the morning and afternoon. Please make sure the snack is healthy: fruits, vegetables, and/or nutritious bars. Please remember we are a peanut/tree nut free facility.

Catering: Children in our 3-6 and elementary program are allowed to bring their own lunch or have their lunch catered. If your child is bringing their lunch, please pack an ice pack to keep items cold. Kids Lunch is our third-party provider for lunches. They offer a regular, vegetarian, and Indian menu. You may choose the number of days you would like your child to have lunch,the food options, and pay through their secured website,www.kidslunch.net. Please be sure to register an account using your child’s name. Full-time toddlers receive lunch daily as part of their tuition.

Toddler, Preschool, & Elementary Laundry Schedule: Parents take turns doing the weekly laundry for the classroom. When it is your week to do laundry, a basket of items to be laundered will be in front of your child’s cubby. Please do not fold laundry as this is work for the children on Mondays which teaches them how to care for our environment.

Toddler, Preschool, & Elementary Inside Shoes: Please bring your child inside shoes to be left at school. These shoes should have a rubber sole, be closed toe and fit well.

Nap: If your child is a full day student and still naps, please bring a crib sheet, small blanket and small pillow, for your child. These items will be sent home on Friday for you to wash. Please put these items in a handled-bag that is labeled with your child’s name and place above your child’s cubby. Normally, children who are over four years of age and do not nap, will be invited back into the Montessori classroom for more Montessori instruction after a short rest period.

DuPage Montessori School Information and Procedures for Naperville Campus

2019-2020 School Year

Conferences: Parent/Teacher conferences are scheduled in November and March/April. If you feel a conference is necessary at any time during the school year, please do not hesitate to contact your teacher.

Tuition: Tuition is due on the 1st day of each month and balances can be viewed through the school website. Payments may be made by cash, check, or credit card (online.) Cash or checks can be placed in the basket outside of the indoor walk-up window or handed to one of our staff members. Please make checks payable to DuPage Montessori School. You may also pay your balance online using Bill Pay through your bank or PaySimple on our secured website.

Field Trips: Field trips will be posted at the beginning of each month in both the school’s newsletter and in your teacher’s newsletter.

Toddler: Two field trips a year - fall and spring. A parent or legal guardian needs to provide transportation and attend these field trips.

Preschool/Elementary: We take approximately one field trip a month. There is no additional cost for the field trips.

After-School Activities: We offer many classes and clubs after school such as art, chess, yoga, soccer, Latin, Spanish, and Mandarin. The instructors include our Montessori teachers, assistants, and third party organizations. Payments are made directly to the teacher. Information and flyers are posted to the school website and are continuously updated.

Playground/Soccer Field:Students are allowed to use the playground/soccer field after school, as long as the parent has signed the playground release form and that all balls are put back into the basket before they leave. The parent is responsible for the student’s health and well-being while on our property after school. Once our after-school children come outside to use the playground or

soccer field, the students who are not in our after-school program must leave.

Newsletters:At the beginning of every month you will receive a school newsletter. This newsletter has important information about field trips and other school events. This newsletter is also posted on our website under Resources/Forms. You will also receive a monthly newsletter from your child’s teacher. This newsletter will share the work that the children are engaged with in the classroom and have specific information regarding your particular classroom. Please make sure you review these newsletters.

Phone calls:Teachers are not available during class time. You may leave a voice mail message or an email and the teachers will return calls or emails after class hours.

Absences:Please call the school before 8:30 am the day the child is going to be absent (sickness, vacation, doctor appointments, etc.) In case of communicable disease (chicken pox, measles, etc.), we want to know your doctor’s recommendation. Please let us know the reason for your child’s absence. After a long absence, 5 days or more, the child may need to readjust to the school routine. We take this into consideration as we welcome them back.

Illness:Children with any of the following symptoms should not be in school: Acute cold. Sore throat. Nausea and vomiting.Diarrhea - child can return to school after 24 hours of regular bowel movementRash or skin eruption. Signs of listlessness, weakness, or chills.Fever -100.5 degrees - may not return to school until child has had 24 hours fever free without medicine. Strep Throat - may not return to school until child has had 24 hours of antibiotics.Swollen glands. Red and watering eyes.

Communicable diseases - any disease that is highly contagious will need a doctor’s note stating that the child is allowed to return to school BEFORE the child comes back to school. A parent may drop-off the note the morning the child returns to school.

If your child has vomited or has diarrhea at school, they will need to be picked up within 30 minutes. If you are unable to pick your child up within 30 minutes, you will need to find an alternative person who can pick-up your child within the 30 minute time period. Please make sure the person you have listed as your emergency contact and or alternative pick-up person is available to pick-up your child when needed.

Medication:The school must have written parental permission for prescribed medication that is to be given to your child. The medication slips are at the door of each classroom. The parent or guardian must fill out these forms before medication can be given. Important notice: Medications are only administered between 12 pm and 1 pm. Make sure the doctor and pharmacist note these times on the medication container. Medication must have a pharmacy label on the container and be dated. Vitamins, store bought medicines, and medicines from other countries cannot be administered at school.

DuPage Montessori School Information and Procedures for Naperville Campus

2019-2020 School Year

Discipline:In the Montessori environment children are guided to develop self-discipline through their work with the classroom materials, their interaction with their peers, and by direct instruction of grace and courtesy by the Head Teacher and classroom assistants. Attempts are made to understand the causes of a child’s behavior and to help them resolve them. Diet, sleep, and home factors, such as separation and divorce of parents, as well as the arrival of new siblings, can play a very important role in a child’s behavior at school.

Discipline is nurtured through offering choices for children and to exercise decision making opportunities for them to help in as many ways as possible. This creates an environment that is easy to manage so that they can be responsible for the things they use, and by our recognition and respect for the child’s developing abilities.

The Directors have established a step-by-step plan for handling difficult discipline situations, which include conferences and goal setting to achieve a balance in helping the child.One approach is to lead a child to a table and have them work there for a while bringing activities to them rather than having them wander through the class. We may also have a child walk with us as we work with other children in the class, having them watch as we work.As a last resort a child may be asked to sit and watch their friends work in the class, returning to work after a few minutes of watching others.

Aggressive Behavior In Children:

Our program believes that early intervention is in the best interest of children, families, and staff.  Our school is committed to addressing development and behavioral issues as soon as they arise.  If our staff identifies developmental concerns, the parents are promptly contacted. The staff will work with the family to share information, make recommendations, and strategize an individual program for meeting the needs of the child. Our staff uses positive guidance techniques when working with children. Some behaviors, such as tantrums, sharing issues, or physical aggression, are typical developmental issues that we see in the Preschool environment.  For safety and health concerns, we take aggressive behavior seriously. While biting, spitting, hitting, pushing, and kicking can be quite natural responses to frustration in the younger child, children over two years old are expected to have outgrown these behaviors. Thus, they are not tolerated in the Early Childhood program (ages 3-6) or in our Elementary Program and will be treated as a serious disciplinary breach by the teachers and Director. We consider bullying to be an aggressive behavior and it will be addressed immediately with the child, parent, and administration.

Our policy for handling aggressive behavior challenges is the following:

• The parents will be contacted with detailed information.

DuPage Montessori School Information and Procedures for Naperville Campus

2019-2020 School Year

DuPage Montessori School Information and Procedures for Naperville Campus

2019-2020 School Year

Discipline continue. • The teacher and/or the Director and parents will meet together to share information, strategize

an action plan to support the child, and set a time for a follow-up meeting. While suspension seems like an extreme solution, it is actually a useful and common tool in handling preschool and elementary misbehavior. It should be regarded by the parent not so much as a punishment, but as an opportunity for the child to forget his/her old pattern and relearn a healthier one.

• During the follow-up meeting, the teacher and/or Director and parents will reflect and reassess the action plan and determine what, if any, future measures shall be taken to support the child.  At that time, we may suggest collaborating with an outside childhood consultant.

• If all of our interventions as well as those made by the family outside of school have not been successful, we may determine that we are unable to meet the needs of the child. After three serious and aggressive behavior incidents we will ask the family to find an alternate placement for the child. In the event that the child is exhibiting behavior that poses a danger to other students or staff, the Director will require that the child be picked up from school immediately that day. It is only on very rare occasions that a child’s behavior may warrant the need to find a more suitable setting for care. Examples of such instance include:

• A child appears to be a danger to him/herself, other children, or staff.• Medical, psychological or social service personnel working with our school determine that

continued care at our school could be harmful or not in the best interest of the child.• Any other situation in which the accommodations required for a child’s success and participation

in school place an undue burden on our resources.

Because our programs are based on developing partnerships and supporting families, it is only on very rare occasions that a parent/guardian’s actions or requests may warrant the need to find a more suitable setting for their child.  Examples of such instances include:

• The parent/guardian fails to abide by our program’s policies.• A parent/guardian demands special services that are not provided to other children and which

our school cannot reasonably deliver, including requests that are outside the philosophy of our program.

• A parent/guardian is physically or verbally abusive to children, staff, or anyone at DuPage Montessori.

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DUPAGE MONTESSORI SCHOOL 1111 E. Warrenville Road Naperville, IL 60563

(630) 369-6899 office@dupageschool.org

Birth Certificate Reminder

Please bring your child’s certified birth certificate at the time of registration. A copy for our file will be made while you wait. You can also send in a color copy of the certificate.

Thank you, Du Page Montessori School

DUPAGE MONTESSORI SCHOOL 1111 E Warrenville Rd. Naperville, IL 60563

(630) 369-6899 office@dupageschool.org

______________________________________________________________________ EMERGENCY CONTACTS _________________________________________________________________________ Student’s Name: ________________________ Home Phone: ________________________ Mother’s Work Phone: ___________________ Father’s Work Phone: __________________ Cell Phone:_____________________________ Cell Phone:__________________________ Should the school be unable to contact us in the event of an emergency, we suggest that one of the following two people below be contacted. (Note: Emergency contact persons should be reliable people, who are available and have transportation during your child’s class time. This must be someone your child knows well and who can be called upon in a emergency to pick up your child and can care for your child.)

1.) _____________________________________ ______________________________________ Name in Full Phone (Area code & Number) ______________________________________ ______________________________________ Street Address City & Zip Code

2.) _____________________________________ ______________________________________ Name in Full Phone (Area code & Number) _____________________________________ ______________________________________ Street Address City & Zip Code

_________________________________________________________________________ ALTERNATE PICK-UP PERSONS (May be same as above) _________________________________________________________________________

1.) _____________________________________ ______________________________________ Name in Full Phone (Area code & Number) ______________________________________ ______________________________________ Street Address City & Zip Code

2.) _____________________________________ ______________________________________ Name in Full Phone (Area code & Number) _____________________________________ ______________________________________ Street Address City & Zip Code

Signature of Parent/ Guardian: ______________________________ Date: ____________________

DUPAGE MONTESSORI SCHOOL

_________________________________________________________________________ HOSPITAL & FIRST AID RELEASE _________________________________________________________________________

Student’s Name: _______________________ Home Phone: ______________________________

Mother’s Work Phone: ___________________ Fathers Work Phone: ______________________

Address: ________________________________________________________________

Physician Name: ________________________ Telephone: _____________________

Hospital Affiliation: ________________________

We give DuPage Montessori School permission to take my child to a hospital in an emergency where such action is deemed urgent by the school. We understand that we will bear full financial responsibility for all costs incurred for medical treatment.

Signature of Parent/ Guardian: ______________________________ Date: ________________

We give DuPage Montessori School permission to administer first aid and give CPR to my child if necessary.

Signature of Parent/ Guardian: ______________________________ Date: ________________

Illinois Department of Public HealthPROOF OF SCHOOL DENTAL EXAMINATION FORM

To be completed by the parent (please print):

To be completed by dentist:

Oral Health Status (check all that apply)

! Yes ! No Dental Sealants Present

! Yes ! No Caries Experience / Restoration History — A filling (temporary/permanent) OR a tooth that is missing because it wasextracted as a result of caries OR missing permanent 1st molars.

! Yes ! No Untreated Caries — At least 1/2 mm of tooth structure loss at the enamel surface. Brown to dark-brown coloration of thewalls of the lesion. These criteria apply to pit and fissure cavitated lesions as well as those on smooth tooth surfaces. If retainedroot, assume that the whole tooth was destroyed by caries. Broken or chipped teeth, plus teeth with temporary fillings, are consid-ered sound unless a cavitated lesion is also present.

! Yes ! No Soft Tissue Pathology

! Yes ! No Malocclusion

Treatment Needs (check all that apply)

! Urgent Treatment — abscess, nerve exposure, advanced disease state, signs or symptoms that include pain, infection, or swelling

! Restorative Care — amalgams, composites, crowns, etc.

! Preventive Care — sealants, fluoride treatment, prophylaxis

! Other — periodontal, orthodontic

Please note____________________________________________________________________________________

Signature of Dentist _________________________________________ Date ____________________________

Address ___________________________________________________ Telephone _______________________Street City ZIP Code

Illinois Department of Public Health, Division of Oral Health217-785-4899 • TTY (hearing impaired use only) 800-547-0466 • www.idph.state.il.us

Printed by Authority of the State of IllinoisP.O.#346085 5M 10/05

Student’s Name: Last First Middle Birth Date:/ /

Address: Street City ZIP Code Telephone:

Name of School: Grade Level: Gender:! Male ! Female

Parent or Guardian: Address (of parent/guardian):

(Month/Day/Year)

Allergy'Action'Plan'

Child’s'Name:'________________________________________________________________________________'

Teacher:'______________________________________________________________________________________'

Allergies:'______________________________________________________________________________________'

_________________________________________________________________________________________________'

_________________________________________________________________________________________________'

Severity:' ' Low' '''''''Moderate' ''''''''High'

Symptoms:'___________________________________________________________________________________'

_________________________________________________________________________________________________'

_________________________________________________________________________________________________'

Treatment:'___________________________________________________________________________________'

_________________________________________________________________________________________________'

_________________________________________________________________________________________________'

_________________________________________________________________________________________________'

Comments:'___________________________________________________________________________________'

_________________________________________________________________________________________________'

_________________________________________________________________________________________________'

________________________________________________________________________________________________'Doctor’s'Signature/Date/Phone'Number'

_________________________________________________________________________________________________'Parent’s'Signature/Date'

Respond to the following questions by circling the appropriate answer. RESPONSE1. Is this child eligible for or enrolled in Medicaid, Head Start, All Kids or WIC? Yes No Don’t Know

2. Does this child have a sibling with a blood lead level of 10 mcg/dL or higher? Yes No Don’t Know

3. Does this child live in or regularly visit a home built before 1978? Yes No Don’t Know

4. In the past year, has this child been exposed to repairs, repainting or renovation of a home built before 1978? Yes No Don’t Know

5. Is this child a refugee or an adoptee from any foreign country? Yes No Don’t Know

6. Has this child ever been to Mexico, Central or South America, Asian countries(i.e., China or India), or any country where exposure to lead from certainitems could have occurred (for example, cosmetics, home remedies,folk medicines or glazed pottery)? Yes No Don’t Know

7. Does this child live with someone who has a job or a hobby that may involvelead (for example, jewelry making, building renovation or repair, bridge construction,plumbing, furniture refinishing, or work with automobile batteries or radiators,lead solder, leaded glass, lead shots, bullets or lead fishing sinkers)? Yes No Don’t Know

8. At any time, has this child lived near a factory where lead is used(for example, a lead smelter or a paint factory)? Yes No Don’t Know

9. Does this child reside in a high-risk ZIP code area? Yes No Don’t Know(see reverse side of page for list)

If there is any “Yes” or “Don’t Know” response; and• the child has proof of two consecutive blood lead test results (documented below) that are each less than 10 mcg/dL

(with one test at age 2 or older), and• there has been no change in the child’s living conditions, a blood lead test is not needed at this time.

Test 1: Blood Lead Result _____mcg/dL Date __________ Test 2: Blood Lead Result _____mcg/dL Date __________

________________________________________________________________ _________________________ Signature of Doctor/Nurse Date

Illinois Lead Program866-909-3572 or 217-782-3517

TTY (hearing impaired use only) 800-547-0466

Childhood Lead Risk QuestionnaireState of IllinoisIllinois Department of Public Health

Printed by Authority of the State of IllinoisIOCI 15-678

ALL CHILDREN 6 MONTHS THROUGH 6 YEARS OF AGE MUST BE EVALUATED FOR LEAD POISONING(410 ILCS 45/6.2)

A blood lead test should be performed on children:• with any “Yes” or “Don’t Know” response• living in a high-risk ZIP code area• all Medicaid-eligible children should have a blood lead test prior to 12 months of age and 24 months of age. If a

Medicaid-eligible child between 36 months and 72 months of age has not been previously tested, a blood lead testshould be performed.

If responses to all the questions are “No”:• re-evaluate at every well child visit or more often if deemed necessary

Child’s name _________________________________________________________ Today’s date _______________

Age________ Birthdate_________________ ZIP Code __________________

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Alexander6291462988

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Cass62611626186262762691

Champaign6181561816618456184961851618526186261872

Pediatric Lead PoisoningHigh-Risk ZIP Code Areas

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KendallNone

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MarionNone

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McHenry60034

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MonroeNone

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Perry6283262997

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PopeNone

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Putnam613366134061363

Randolph622176224262272

Richland6241962425

Rock Island612016123661239612596126561279

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Saline6293062946

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Wabash624106285262863

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Washington6221462803

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Woodford6151661545615706176061771

April 2015Printed by Authority of the State of Illinois

State of IllinoisIllinois Department of Public Health

IOCI 15-678

State of Illinois

Certificate of Child Health Examination

IL444-4737 (R-01-12) (COMPLETE BOTH SIDES) Printed by Authority of the State of Illinois

Student’s Name Last First Middle

Birth Date Month/Day/Year

Sex Race/Ethnicity School /Grade Level/ID#

Address Street City Zip Code

Parent/Guardian Telephone # Home Work

IMMUNIZATIONS: To be completed by health care provider. Note the mo/da/yr for every dose administered. The day and month is required if you cannot determine if the vaccine was given after the minimum interval or age. If a specific vaccine is medically contraindicated, a separate written statement must be attached explaining the medical reason for the contraindication.

Vaccine / Dose 1 MO DA YR

2 MO DA YR

3 MO DA YR

4 MO DA YR

5 MO DA YR

6 MO DA YR

DTP or DTaP

Tdap; Td or Pediatric DT (Check specific type)

�Tdap�Td�DT �Tdap�Td�DT �Tdap�Td�DT �Tdap�Td�DT �Tdap�Td�DT �Tdap�Td�DT

Polio (Check specific type)

� IPV � OPV � IPV � OPV � IPV � OPV � IPV � OPV � IPV � OPV � IPV � OPV

Hib Haemophilus influenza type b

Hepatitis B (HB)

Varicella (Chickenpox)

COMMENTS:

MMR Combined Measles Mumps. Rubella

Single Antigen Vaccines

Measles Rubella Mumps

Pneumococcal Conjugate

Other/Specify Meningococcal, Hepatitis A, HPV, Influenza

Health care provider (MD, DO, APN, PA, school health professional, health official) verifying above immunization history must sign below. If adding dates to the above immunization history section, put your initials by date(s) and sign here.) Signature Title Date Signature Title Date ALTERNATIVE PROOF OF IMMUNITY 1. Clinical diagnosis is acceptable if verified by physician. *(All measles cases diagnosed on or after July 1, 2002, must be confirmed by laboratory evidence.) *MEASLES (Rubeola) MO DA YR MUMPS MO DA YR VARICELLA MO DA YR Physician’s Signature 2. History of varicella (chickenpox) disease is acceptable if verified by health care provider, school health professional or health official. Person signing below is verifying that the parent/guardian’s description of varicella disease history is indicative of past infection and is accepting such history as documentation of disease. Date of Disease Signature Title Date 3. Laboratory confirmation (check one) ¨ �Measles �Mumps �Rubella �Hepatitis B �Varicella Lab Results Date MO DA YR (Attach copy of lab result)

VISION AND HEARING SCREENING BY IDPH CERTIFIED SCREENING TECHNICIAN

Date Code: P = Pass F = Fail U = Unable to test R = Referred G/C = Glasses/Contacts

Age/ Grade

R L R L R L R L R L R L R L R L R L

Vision Hearing

FOR USE IN DCFS LICENSED CHILD CARE FACILITIES CFS 600 Rev 11/201

Student’s Name Birth Date Sex School Grade Level/ ID # Last First Middle Month/Day/ Year

HEALTH HISTORY TO BE COMPLETED AND SIGNED BY PARENT/GUARDIAN AND VERIFIED BY HEALTH CARE PROVIDER ALLERGIES (Food, drug, insect, other) MEDICATION (List all prescribed or taken on a regular basis.)

Diagnosis of asthma? Child wakes during the night

hi ?

Yes No Yes No

Loss of function of one of paired organs? (eye/ear/kidney/testicle)

Yes No

Birth defects? Yes No Hospitalizations? When? What for?

Yes No

Developmental delay? Yes No

Blood disorders? Hemophilia, Sickle Cell, Other? Explain.

Yes No Surgery? (List all.) When? What for?

Yes No

Diabetes? Yes No Serious injury or illness? Yes No

Head injury/Concussion/Passed out? Yes No TB skin test positive (past/present)? Yes* No *If yes, refer to local health department. Seizures? What are they like? Yes No TB disease (past or present)? Yes* No

Heart problem/Shortness of breath? Yes No Tobacco use (type, frequency)? Yes No

Heart murmur/High blood pressure? Yes No Alcohol/Drug use? Yes No

Dizziness or chest pain with exercise?

Yes No Family history of sudden death before age 50? (Cause?)

Yes No

Eye/Vision problems? _____ Glasses � Contacts � Last exam by eye doctor ______ Other concerns? (crossed eye, drooping lids, squinting, difficulty reading)

Dental � Braces � Bridge � Plate Other

Ear/Hearing problems? Yes No Information may be shared with appropriate personnel for health and educational purposes. Parent/Guardian Signature Date Bone/Joint problem/injury/scoliosis? Yes No

PHYSICAL EXAMINATION REQUIREMENTS Entire section below to be completed by MD/DO/APN/PA HEAD CIRCUMFERENCE HEIGHT WEIGHT BMI B/P

DIABETES SCREENING (NOT REQUIRED FOR DAY CARE) BMI>85% age/sex Yes� No� And any two of the following: Family History Yes � No � Ethnic Minority Yes� No � Signs of Insulin Resistance (hypertension, dyslipidemia, polycystic ovarian syndrome, acanthosis nigricans) Yes� No � At Risk Yes � No �

LEAD RISK QUESTIONNAIRE Required for children age 6 months through 6 years enrolled in licensed or public school operated day care, preschool, nursery school and/or kindergarten. Questionnaire Administered ? Yes � No � Blood Test Indicated? Yes � No � Blood Test Date (Blood test required if resides in Chicago.) TB SKIN OR BLOOD TEST Recommended only for children in high-risk groups including children immunosuppressed due to HIV infection or other conditions, frequent travel to or born in high prevalence countries or those exposed to adults in high-risk categories. See CDC guidelines. No test needed � Test performed � Skin Test: Date Read / / Result: Positive � Negative � mm ______________ Blood Test: Date Reported / / Result: Positive � Negative � Value ______________

LAB TESTS (Recommended) Date Results Date Results Hemoglobin or Hematocrit Sickle Cell (when indicated) Urinalysis Developmental Screening Tool

SYSTEM REVIEW Normal Comments/Follow-up/Needs Normal Comments/Follow-up/Needs Skin Endocrine

Ears Gastrointestinal

Eyes Amblyopia Yes� No� Genito-Urinary LMP

Nose Neurological

Throat Musculoskeletal

Mouth/Dental Spinal Exam

Cardiovascular/HTN Nutritional status

Respiratory � Diagnosis of Asthma Mental Health

Currently Prescribed Asthma Medication: � Quick-relief medication (e.g.Short Acting Beta Antagonist ) � Controller medication (e.g. inhaled corticosteroid)

Other

NEEDS/MODIFICATIONS required in the school setting

DIETARY Needs/Restrictions

SPECIAL INSTRUCTIONS/DEVICES e.g. safety glasses, glass eye, chest protector for arrhythmia, pacemaker, prosthetic device, dental bridge, false teeth, athletic support/cup

MENTAL HEALTH/OTHER Is there anything else the school should know about this student? If you would like to discuss this student’s health with school or school health personnel, check title: � Nurse � Teacher � Counselor � Principal EMERGENCY ACTION needed while at school due to child’s health condition (e.g. ,seizures, asthma, insect sting, food, peanut allergy, bleeding problem, diabetes, heart problem)? Yes � No � If yes, please describe. On the basis of the examination on this day, I approve this child’s participation in (If No or Modified,please attach explanation.) PHYSICAL EDUCATION Yes � No � Modified � INTERSCHOLASTIC SPORTS (for one year) Yes � No� Limited �

Print Name (MD,DO, APN, PA) Signature Date

Address Phone

(Complete both sides)

DUPAGE MONTESSORI SCHOOL 1111 E. Warrenville Road Naperville, IL 60563

_________________________________________________________________________ PARENT HANDBOOK: VERIFICATION OF RECEIPT _________________________________________________________________________

I/We ________________________________________________________________________________

parent(s) of _________________________________________________________________________,

certify that I/We have reviewed online a copy of the DuPage Montessori School Handbook,

and have gone through all of the information that it contains pertaining to my child’s school

including but not limited to:

Guidelines and Discipline

Late Pick-Up Policy

Communication and Illness Policy

Pesticide Policy

Scheduled Days Policy - Toddler and Preschool

Toddler’s Daily Report

School Records and Tuition Policies

Signature of Parent/ Guardian: ______________________________________ Date: ______________

Please return to school within 3 school days. This completed form will be filed with the student’s records.

DuPage Montessori School Child’s Profile (3-6)

Child’s Name:_____________________Birth Date:______________ Date:_____________________

Each child is unique, and knowing about his or her activities, interests, habits and history help us to better understand your child. Answering the following questions about your child would be helpful to the staff to serve your child’s needs.

Siblings and ages___________________________________________________________________

_________________________________________________________________________________

Were there any difficulties during pregnancy or birth? ______________________________________

_________________________________________________________________________________

Has your child had any serious illnesses or accidents? _____________________________________

_________________________________________________________________________________

Allergies_______________________________Medications_________________________________

Health Restrictions___________________________Physical Impairments______________________

Age walked__________ Age of first word____________ Age of first sentence___________________

Language spoken at home_____________________________________________________________

Does your child speak and understand English?____________________________________________

Age gave up bottle____________ Does your child feed himself/herself? _______________________

What does your child typically eat for breakfast?__________________________________________

Does your child have a security blanket or toy? ___________________________________________

When did your child first learn to use the toilet? _________________________________________

Is your child toileting independently? _________________________________________________

What type of play materials (toys) does your child use most frequently?______________________

________________________________________________________________________________

________________________________________________________________________________

What TV programs does your child watch? _____________________________________________

________________________________________________________________________________

What period of time per day? ________________________________________

Does your child have any other activities or classes he/she attends? __________________________

________________________________________________________________________________

How does your child act when separating from you? _____________________________________

_______________________________________________________________________________

Does your child initiate his/her own activities? Never ____________Seldom _______________ Sometimes _____________Often _____________

Does your child dress himself/herself?________________________________________

Can she/he button? ______ zip?____ tie?_______ put on a coat?______ shoes?________

Does your child play alone? Never________ Seldom________ Often________ Always__________

Do other children tend to stimulate your child?________Make him/her shy?__________

Cause him/her to lose control?_______________ Have little or no effect?____________

How does your child act when ill? ____________________________________________________

________________________________________________________________________________

How does your child act when hurt? ___________________________________________________

List any fears your child has _________________________________________________________

Regular bedtime_______ p.m. How long does he/she nap?_________________________________

What do you do when he/she has trouble sleeping?________________________________________

________________________________________________________________________________

When you find it necessary to discipline your child, what do you do and who administers it? Mother:__________________________________________________________________________

________________________________________________________________________________

Father: __________________________________________________________________________

________________________________________________________________________________

Other: __________________________________________________________________________

What rewards are used (if any)? ______________________________________________________

________________________________________________________________________________

Is this your first Montessori school experience? _________If not, what was your past experience and

impression of Montessori education?___________________________________________________

_________________________________________________________________________________ Name of school____________________________________________________________________ What do you hope your child will gain or learn from his/her experience here? _________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Do you have any concerns in your child’s development?__________________________________

If so, in what areas? _______________________________________________________________

_______________________________________________________________________________

What area of parent education are you interested in? _____________________________________

_______________________________________________________________________________

Are you available to volunteer during the day?__________________________________________

Days and times available___________________________________________________________ Please list anything else you think would be helpful in aiding and understanding the development of your child: ____________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Signature: __________________________________________________________

Relation to child: ____________________________________________

DUPAGE MONTESSORI SCHOOL

PLAYGROUND AND SOCCER FIELD AUTHORIZATION, RELEASE, AND WAIVER OF LIABILITY AGREEMENT

page 1

*Please list all children who will be playing after school on the DuPage Montessori School playground and soccer field

Child’s Name:________________________________________ Date of Birth:________________

Child’s Name:________________________________________ Date of Birth:________________

Child’s Name:________________________________________ Date of Birth:________________

Child’s Name:________________________________________ Date of Birth:________________

Parent or Legal Guardian Responsible for Child(ren) After-school

Name:_______________________________________________________________

Address:_____________________________________________________________

City:_________________________ State:____________ Zip:___________________

Phone:(home) :_______________________(cell)_____________________________

E-mail:_______________________________________________________________

DUPAGE MONTESSORI SCHOOL PLAYGROUND AND SOCCER FIELD AUTHORIZATION, AFTER-SCHOOL RELEASE AND LIABILITY WAIVER AGREEMENT

page 2

I,__________________________________(parent or legal guardian) for myself and for my child(ren) agree to all of the following:

• I wish for my child(ren) to play on the DuPage Montessori School Playground and/or Soccer Field after the school day and while no staff member is present.

• I realize that I will have to be present and am completely responsible for watching my child(ren) actively participate in their activities while they are on the DuPage Montessori Playground and/or Soccer Field after-school. I understand that young children may get hurt while playing with other children and while engaging in physical activities, and that there is a risk of property damage, serious injury, or death inherent in my child after-school participating on the DuPage Montessori School Playground and Soccer Field.

• I understand that I will be held monetarily responsible for any property/equipment that is damaged by my child(ren).

• I also understand that there are risks inherent in any physical activity program, including the use of equipment such as those provided for use and the fencing and concrete curbs that surround the area at DuPage Montessori School Playground and Soccer Field, which may or may not be obvious and which may pose serious threats to any person if used improperly.

• I acknowledge that the equipment at DuPage Montessori School Playground and Soccer Field is designed for use by young children, adolescents, and teens.

• Although I understand that DuPage Montessori School has attempted to create an injury free play area for my child(ren), a child needs constant attention, and I agree to be either personally responsible for providing that attention, or to appoint another caregiver to provide that attention.

• In the event my child(ren) becomes injured or sick while participating on the DuPage Montessori School Playground and/or Soccer Field, I will be responsible for giving my child(ren) First Aid.• I agree to follow any instructions or rules established by DuPage Montessori School with regard to my

child(ren). I understand and agree that at any time, DuPage Montessori School reserves the right to require me to remove my child(ren) from any activity for any reason.

• I agree not to hold DuPage Montessori School responsible for any injuries suffered by my child(ren) while involved in activities after-school on the DuPage Montessori School Playground and/or Soccer Field.

• I agree to Release, Discharge, NOT SUE, AND TO SAVE AND HOLD HARMLESS DuPage Montessori School, its owners, officers, directors, and employees, from any loss, liability, damage, or costs whatsoever arising out of or related to any loss, damage, or injury (including death) to me or my child(ren) arising out of or in anyway connected with participation in the after-school activities on the DuPage Montessori School Playground and/or Soccer Field for any reason or cause.

I HAVE READ THIS DOCUMENT AND AGREE TO ALL OF ITS TERMS. I UNDERSTAND IT IS A LEGALLY BINDING AGREEMENT AND WAIVES CERTAIN LEGAL RIGHTS OF MINE, INCLUDING, BUT NOT LIMITED TO A RELEASE, WAIVER, PROMISE NOT TO SUE AND A HOLD HARMLESS FOR ALL CLAIMS, THIS AGREEMENT SHALL BE BINDING UPON MYSELF, MY CHILD(REN), AND OUR ESTATE, SUCCESSORS, AND ASSIGNS.

Signature____________________________________________________Date______________________

Personal Supplies ☐ 2 fully labeled sets of weather appropriate clothing including underwear and

socks in a Ziploc bag with your child’s name on the bag

☐ Inside canvas shoes

***Please buy shoes that fit properly. Velcro, zippers, and slip-on shoes with rubber soles are recommended. Crocs and croc-like shoes are not recommended for the

classroom.

☐ Reusable lunch bag with ice pack ☐ 1 backpack with 3 pockets

Nap Supplies - please label all items

☐ 1 small blanket ☐ 1 crib sheet ☐ 1 small pillow ☐ 1 large bag to hold a blanket, pillow and stuffed animal (a pillowcase work best)

3 to 6

YearsPreschool and

Kindergarten 2019-2020 Supply List