ADMISSION FORM

Health Details
Doctor's Name *

First Name Last Name
Doctor's Telephone No. *

Area Code Phone Number
Details of ANY Allergies or Handicaps
Anything Else We Should Know About Your Child
Rides

I authorize the following people to pick up my child from Boa Ventura Montessory School
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Name *

First Name Last Name
Phone Number *

Area Code Phone Number

Admission Details
Proposed Term of Entry *

Day Month Year
Date
Proposed Term of Leaving *

Day Month Year
Date
I give permission to allow a staff member of Boa Ventura Montessory School to transport my child to Clínica Europa to be attended to by a health care profissional in case none of my child's emergency contacts answer at the time of call and if Adélia believes it to be in the interest of my child.
I agree to abide by the Conditions of the School, a copy of which I have received.
Digital Signature *
Or a photography of your signature
Date *

Day Month Year
Date
I Enclose an Enrolment Fee ON ADMISSION (Non-returnable)
€
Should be Empty:

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Child Info