Forms at MLC

At MLC, the safety and protection of our students is our top priority. The forms provided here—including our Media and Medical Release forms—help us maintain clear communication with families and ensure that each child’s individual needs are respected. These guidelines allow us to create a secure and supportive environment for learning and growth.

Media Release Form

This form allows parents or guardians to provide consent regarding the use of photographs, videos, and other media featuring their child. Images or recordings may be used for school-related purposes such as our website, social media pages, newsletters, or promotional materials. Completing this form lets us know your preferences and ensures we respect your family’s privacy.

Student Media Release Policy & Consent Form

Student Full Name*

Date of Birth*

Grade & Program*

Parent/Guardian Full Name*

Parent/Guardian Phone Number*

Parent/Guardian Email Address*

This form authorizes Montessori Learning Center (MLC), a private school, to capture and use photographs, video, audio, and student work for educational and school-related communication purposes.*

I confirm that I have read and understand the statement above.

The types of media covered include: Individual and group photographs, video recordings, audio recordings (including voice), student work that may include identifying media.*

I confirm that I have read and understand the statement above.

Once media is shared on approved platforms, it may be reshared by others. Montessori Learning Center does not have control over further redistribution.*

I confirm that I have read and understand the statement above.

Media will be used respectfully and for educational purposes only, media will not be used for commercial purposes, no compensation will be provided for use of media. Student privacy and dignity will be respected.*

I confirm that I have read and understand the statement above.

Media Platform Consent: Instagram (@ mlc.school1)*

I consent to my child’s photo and/or video being shared on MLC’s official Instagram account.

I do not consent to my child’s photo and/or video being shared on MLC’s official Instagram account.

Media Platform Consent: Facebook*

I consent to my child’s photo and/or video being shared on MLC’s official Facebook account.

I do not consent to my child’s photo and/or video being shared on MLC’s official Facebook account.

Media Platform Consent: Digital Newsletter*

I consent to my child’s photo and/or video being shared on MLC’s official digital newsletter.

I do not consent to my child’s photo and/or video being shared on MLC’s official digital newsletter.

Media Platform Consent: Parent WhatsApp Group*

I consent to my child’s photo and/or video being shared on MLC’s Parent WhatsApp Group.

I do not consent to my child’s photo and/or video being shared on MLC’s Parent WhatsApp Group.

Media Platform Consent: Website*

I consent to my child’s photo and/or video being shared on MLC’s official website.

I do not consent to my child’s photo and/or video being shared on MLC’s official website.

Consent may be withdrawn at any time by written request via email to mlcschool@gmail.com. Withdrawal applies to future use only. Images, recordings, or other media collected and used while consent was in effect may continue to be used and remain on any of the previously consented platforms. Withdrawal of consent means that no new photos or media of your child will be taken or used going forward; it does not require the removal of materials created or published prior to the date consent is withdrawn.*

I confirm that I have read and understand the statement above.

Consent remains valid while the student is enrolled at Montessori Learning Center unless withdrawn in writing.*

I confirm that I have read and understand the statement above.

By entering my name below, I certify that I am the parent or legal guardian of the student and that I consent to the media release terms described above.*

Emergency Information and Medical Release Form

This form provides essential medical and emergency contact information to be used in the event of an illness, accident, or other urgent situation involving a student. All information will remain confidential and will be used solely for the purpose of protecting the health and safety of the student.

Student Emergency Information and Medical Release Form

Student Full Name*

Date of Birth*

Grade*

Home Address*

City, State, and Zip Code*

Parent/Guardian #1 Full Name*

Relationship to Student (Parent/Guardian #1)*

Cell Phone Number (Parent/Guardian #1)*

Work Phone Number (Parent/Guardian #1)

Home Phone Number (Parent/Guardian #1)

Email (Parent/Guardian #1)*

Parent/Guardian #2 Full Name*

Relationship to Student (Parent/Guardian #2)*

Cell Phone Number (Parent/Guardian #2)*

Work Phone Number (Parent/Guardian #2)

Home Phone Number (Parent/Guardian #2)

Email (Parent/Guardian #2)*

Emergency Contact #1 Full Name (Other than Parents)*

Emergency Contact #1 Relationship to Student*

Emergency Contact #1 Cell Phone Number *

Emergency Contact #1 Email *

Emergency Contact #2 Full Name (Other than Parents)*

Emergency Contact #2 Relationship to Student *

Emergency Contact #2 Cell Phone Number*

Emergency Contact #2 Email

Primary Care Physician Full Name*

Primacy Care Physician's Phone Number*

Preferred Hospital*

Insurance Provider*

Does the student have any allergies? If yes, please list and describe reactions.*

Does the student have any medical conditions? If yes, please describe.*

Is the student currently taking any medications? If yes, please list medications and dosages.*

Additional Information: Please use the space below to share any additional information that may be helpful or necessary for school staff or emergency personnel to know. If not applicable, disregard this section.

By entering my name below, I certify that I am the parent or legal guardian of the student and I authorize school personnel to seek and obtain necessary emergency medical treatment for my child in the event that I cannot be reached in an emergency.*

Before & After School Care Registration Form

Please complete this form to register your child for Before School Care, After School Care, or both. The Before/After School Care program is from Monday to Thursday. Note that all payments are due before the start of each month. The information collected will assist us in providing a safe, organized, and supportive care program.

Student's Full Name*

Date of Birth*

Grade Enrolled

Which care would you like to enroll your child in? Please note that payment is required before the start of each month.

Before School Care 7:00 AM to 8:30 AM, $100/month per student

After School Care 2:30 PM to 5:30 PM, $150/month per student

Both (Before & After School Care), $250/month per student

Who is authorized to pick-up your child? State individual's full name, relationship to student, & mobile number.*

Who is authorized to pick-up your child? List any individuals other than the above. State each individual's full name, relationship to student, & mobile number.

I declare that:*

The information provided is true and correct. I will notify the school of any changes. I agree to comply with all school policies. I understand that fees apply in accordance with MLC's fee schedule.

Montessori Learning Center

Empowering students through holistic educational experiences.

+1 (909) 900-4390

info@mlcschool.net

7605 Sierra Ave, Fontana, CA 92336

Forms at MLC

Media Release Form

Emergency Information and Medical Release Form

Employee Media Release Policy

Before & After School Care Registration Form

Montessori Learning Center

Contact Info

Newsletter/Inquiry