APPLICATION FOR ADMISSION

Applying for year:

——

Please check program(s) applying to:

Morning Primary Program (2 ½ to 4 year olds) 8:45 am – 12:00 pm

Half-Day Primary Program (2 ½ to 4 year olds) 8:45 am – 1:00 pm (includes lunch hour)

Full Day Primary Program (2 ½ to 4 year olds) 8:45 am – 3:00 pm

Kindergarten Program (5 years old by September 1st) 8:45 am – 3:00 pm

*After-School Care Program 3:00pm-6:00pm

*(to be offered with a minimum enrollment of four children)

*

CHILD INFORMATION

Full Name (First, Middle, Last)

Commonly Used First Name (if different)

Date of Birth required

Current Age

Previously attended school?

Yes

Name of Previous School (if applicable)

Primary Language Spoken in the Home

Gender

Male

Female

*

FAMILY INFORMATION

Parent/Guardian Full Name

Home Address

City, State, Zip

Relationship to Applicant

Employer

Cell Phone

Email Address

Are there other children in residence?

Name

Age

*

Parent/Guardian Full Name

Home Address (if different)

City, State, Zip

Relationship to Applicant

Employer

Cell Phone

Email Address

Child lives with

Father

Mother

Both

GENERAL HEALTH INFORMATION

Is your child under the care of a doctor other than a pediatrician?(Details)

Does your child have any physical/mental disabilities that require special attention? (Details))

Does your child have any allergies? (Deteils)

Yes

Age learned to talk?

Does your child have any health issue you think is important to tell us about, and has not been previously mentioned, e.g. speech therapy?

Does your child feed him/herself?

Yes

Does your child dress him/herself?

Yes

Is your child fully toilet trained?

Yes

Bathroom independence is required before the first day of school.

Age learned to walk?

How did you learn about Crestview Montessori School?

Please explain your interest in a Montessori school environment for your child:

If your child has an IFSP/IEP please share a copy with us. This will help us address any individual needs your child may have.

Parent /Guardian Name

Signature