1. automotive and vehicles
2. campers and rvs

Summer Math
M3S Enrichment &
Elementary Tutoring
5
1
e
n
Ju
7
1
y
Jul 5
201
www.millhopper.com
facebook.com/millhoppermontessorischool
Contact 352-375-6773
for more information
Ms. Susan Hansen & Ms. Susan Salvatore
Middle School Summer Math Enrichment
Rising 6th - 8th Grade MMS Students
SCHEDULE & FEES
M3S 6th - 8th Grade
Morning Program *
7:30—9:00 a.m.
$5.50/hour
Full Day Option
9:00 a.m.—3:00 p.m.
$295/Week or
$1495 for 5 weeks
After Camp Program** 3:00—5:30 p.m.
$5.50/hour
*The Morning Program and After Camp
Program are charged at a rate of $5.50/hour
The Middle School Math Enrichment
Camp is available to rising 6th - 8th
grade MMS students. The camp will
run for five weeks; June 15 - July 17th
from 9:00 a.m. - 3:00 p.m. daily; with
an hour for lunch and recess from
noon - 1:00 p.m.
While we will be moving through the
material at a rapid pace, students are
not required to attend every week.
and are billed after use. Family’s second and
each subsequent child will be charged half
price for morning and after camp fees.
TERMS: Due to high demand and limited
camp space, a non-refundable deposit equal
to one week’s camp tuition is due upon
In addition to math enrichment work,
camp will also include games, problem
solving, critical thinking skills and
splash day on Fridays.
enrollment to hold a spot for each child.
If MMS is not notified a minimum of four
Camp Dates:
weeks before the camp start date of your
intent to withdraw, you will be responsible for
June 15 - 19
June 22 - 26
June 29 - July 2
July 6 - 10
July 13 - 17
payment for the entire week of camp.
MEALS & SNACKS
All students will need to bring their lunches.
Please note, lunches cannot be heated or
refrigerated. Snacks are
provided mid-morning and during the After
Camp .
Every Friday is SPLASH DAY
Splash Day is a fun filled hour of water related activities.
2
Summer Middle School Math Enrichment
Registration Form
$295/week or $1495 for all 5 weeks
Child’s Name: _________________________________
Week 1
June 15 - 19
Week 2
June 22 - 26
Week 3
June 29 - July 2
Week 4
July 6 - 10
Week 5
July 13 - 17
( ) Math Enrichment
( ) Math Enrichment
( ) Math Enrichment
( ) Math Enrichment
( ) Math Enrichment
Rising 6th - 8th Grade
M3S Students Only
Rising 6th - 8th Grade
M3S Students Only
Rising 6th - 8th Grade
M3S Students Only
Rising 6th - 8th Grade
M3S Students Only
Rising 6th - 8th Grade
M3S Students Only
After Camp Elementary Math
Small Group with Ms. Susan Salvatore | $55.00/session
Ms. Susan Salvatore will be teaching private math lessons from 3:30 - 5:15 p.m.; Monday Thursday. Lessons will focus on math for rising 1st - 5th grade students. Lessons are filled on
a first come first serve basis and will be offered every afternoon in 45 minute increments
(3:30 - 4:15 p.m. & 4:30 - 5:15 p.m.). In order to keep the lessons individualized, please note
there is a two student maximum per session. To register for After Camp Elementary Math,
please contact Ms. Susan Salvatore to schedule the exact day/time at
ssalvatore@millhopper.com.
Week 1 June 8-12
Week 2 June 15-19
Week 3 June 22-26
Week 4 June 29-July 2
( )After Camp
Elementary Math
( )After Camp
Elementary Math
( )After Camp
Elementary Math
( )After Camp
Elementary Math
Week 5 July 6-10
Week 6 July 13-17
Week 7 July 20-24
Week 8 July 27-31
( )After Camp
Elementary Math
( )After Camp
Elementary Math
( )After Camp
Elementary Math
( )After Camp
Elementary Math
Camp tuition is paid through Tuition Express the Friday before each week of camp. You may pay by ACH or credit card. You may obtain these forms online or
at the front desk. Please submit one of them with your registration paperwork along with the deposit equal to one week’s camp tuition to register.
I understand that by signing below, I am enrolling my child in summer camp at Millhopper Montessori School. It is my responsibility to notify Millhopper
Montessori in writing a minimum of four weeks before a scheduled camp if I wish to cancel for any reason. Failure to notify the school in writing will result in my
account being charged for the week(s) of camp I have indicated above. I attest that I have submitted all of the required documents to Millhopper Montessori
School and that I have read the above information and understand this to be a binding agreement.
________________________________________ ________________________________________
Primary Parent’s signature
Secondary Parent’s signature
3
Summer Math Enrichment Application
Child's Name:
Birth date:
_______________________________________________________________________
(Last)
(First)
(Middle)
(Alias)
____/_____/_____
Gender:
_______
Child Lives With: ________________________
Primary Parent’s Name :______________________________ Relationship to Child: _____________________
Address Information:
_______________________________________________________________________________________
Home Address
City/State/ Zip
_______________________________________________________________________________________
Work Address
City/State/Zip
_______________________________________________________________________________________
Email Address
Phone Information (please circle the number we should call first):
(______)_____________________ (______)_______________________(______)____________________
Home Phone
Work Phone
Cell Phone
If your child is currently enrolled at MMS & all information on file is correct please initial here _____.
You do not need to fill out the information below.
Secondary Parent’s Name :______________________________ Relationship to Child: __________________
Address Information:
_______________________________________________________________________________________
Home Address
City/State/ Zip
_______________________________________________________________________________________
Work Address
City/State/Zip
_______________________________________________________________________________________
Email Address
Phone Information (please circle the number we should call first):
(______)_____________________ (______)_______________________(______)____________________
Home Phone
Work Phone
Cell Phone
Additional Pickup & Emergency Contacts
Name : ______________________________________
Name : ______________________________________
Relationship to child: ___________________________
Relationship to child: ___________________________
Cell Phone :
Cell Phone :
(______)__________________________
Home Phone: (______)__________________________
Pickup Permitted
(______)__________________________
Home Phone: (______)__________________________
Emergency Only
Pickup Permitted
Emergency Only
Name : ______________________________________
Name : ______________________________________
Relationship to child: ___________________________
Relationship to child: ___________________________
Cell Phone :
Cell Phone :
(______)__________________________
Home Phone: (______)__________________________
Pickup Permitted
(______)__________________________
Home Phone: (______)__________________________
Emergency Only
Pickup Permitted
4
Emergency Only
Picture Release
Name of Child
___________________________________________________________
Primary Parent’s Name
___________________________________________________________
Secondary Parent’s Name
___________________________________________________________
I hereby give permission for Millhopper Montessori School to use photographs and/or video footage of my child as needed on the
schools website, in the school’s newsletter, magazines, social networks and newspapers. I understand compensation will not be
awarded for the use of my child’s photographs and/or video footage. I hereby release any and all claims to said photographs and/
or video footage both present and future. Please select the appropriate disclaimer below. I, ______________________________,
authorize the Millhopper Montessori School to use pictures and/or video footage of my child/ren on the schools website, in the
school’s newsletter, yearbook, magazines, social networks and newspapers. OR I, _____________________________________,
authorize the Millhopper Montessori School to use pictures and/or video footage of my child/ren on the schools website, in the
school’s newsletter, yearbook, magazines, social networks and newspapers, and I request that surnames not be used in print to
protect my child’s identity. OR ___________________________________, do not authorize the Millhopper Montessori School to
use pictures and/or video footage of my child/ren on the schools website, in the school’s newsletter, yearbook, magazines, social
networks and newspapers.
MMS incorporates food preparation in the Montessori curriculum area of Practical Life
Allergies & Food/Diet Restrictions
**MMS does not have a nurse on staff. The teachers and assistant teachers are all certified in first aid and CPR. MMS can give
medication orally or assist with an Epi-Pen if the parent has filled out the appropriate form for the dispensing of medicine.
**If a child is allergic to an ingested substance (such as red food coloring or chocolate) and is old enough to monitor himself or
herself, there should not be any difficulty in the MMS environment. It is the parent’s responsibility to have alternate food
available for birthday parties or the child can be proactive and abstain from special snacks. It will not be the responsibility of the
school or the teachers to notify parents in advance of an in-class event such as a special snack or a practical life activity
containing food. Allergies, Medicine, Environmental & Food/Diet Related Restrictions (List all known)
Allergen
______________________
______________________
______________________
Reaction
_____________________
_____________________
_____________________
Medical protocol if exposed
_____________________________
_____________________________
_____________________________
Medical Release
In case of emergency, MILLHOPPER MONTESSORI SCHOOL, or its staff, has my permission to have my child
______________________________________, transported to the closest hospital at the time. I understand that MMS will make every effort to contact me
and my child's physician in an emergency. If it is
necessary for my child to be transferred to a hospital, I would prefer he/she be taken to ____________________________________. (Name of Hospital)
In the event that I cannot be reached by the MMS in an emergency, I give my permission to _____________________________________, (CHILD'S
PHYSICIAN) to render any medical service that may, in the sole discretion of the doctor, be necessary.
Guarantee of Insurance
Children attending Millhopper Montessori School, Inc. must have health insurance through their families. MMS’ insurance works
as a secondary policy alongside a family’s policy and the Administrator needs proof of insurance. Please provide the following
information:
Primary Payer
_________________________________________
Secondary Payer
_________________________________________
Child or children’s name(s)
________________________________
________________________________
________________________________
Name and address of insurance company
____________________________________
____________________________________
Phone Number of insurance company ____________________________________
Policy Number
____________________________________
I guarantee that the above information is correct and I understand that it is my responsibility to inform Millhopper Montessori
School, Inc. of any changes in insurance coverage for my child.
________________________________________ ________________________________________
Primary Parent’s signature
Secondary Parent’s signature
5