Student Application Form Montessori & Me Student Application FormAdmission Requested For:*2023-242024-25Child's Information:Child's Name* Child's First Name Child's Last Name Child's DOB (MM/DD/YYYY)* Date Format: MM slash DD slash YYYY Child's Gender*FemaleMaleHome Address* Street Address City State / Province / Region ZIP / Postal Code Home Phone Number*Child's First Language*Language(s) spoken at home*Preferred Program Time:*AM Program, Monday – Friday 8:00 am – 11:30 amPM Program, Monday – Friday 12:45 pm – 4:15 pmParent/Guardian Information:Parent/Guardian #1 Information:Parent/Guardian #1 Name* Parent/Guardian #1 First Name Parent/Guardian #1 Last Name Relationship to Child*Parent Email* Work Phone Number*Cell/Home Phone Number*Occupation/Title*Parent/Guardian #2 Information:Parent/Guardian #2 Name* Parent/Guardian #2 First Name Parent/Guardian #2 Last Name Relationship to Child*Parent Email* Work Phone Number*Cell/Home Phone Number*Occupation/Title*Does your child have siblings?*YesNoSibling:*NameAge Financial Responsibility of the Student's Tuition Will Be Assumed By:Name*Phone*Relationship to Child*Other Information:Does Your Child Currently Attend A Preschool Or Daycare?*YesNoIf yes, please specify*Is your child potty trained?*YesNoIn ProgressIs your child frightened of anything that we should be aware of?*YesNoIf yes, please specify*Are there any medical or emotional concerns that we should be aware of?*YesNoIf yes, please specify*Are your child's immunizations up to date?*YesNoAre there any dietary restrictions that your child must follow?*YesNoIf yes, please specify*Does your child have any allergies or physical limitations?*YesNoIf yes, please specify*Is your child on medication?*YesNoIf yes, please specify*Has your child ever suffered any serious illness, injury or hospitalization?*YesNoIf yes, please specify*Has your child had any specialized evaluations or received any counseling or therapy?*YesNoIf yes, please specify*Does your child have any special needs?*YesNoIf yes, please specify*Has your child's present preschool/daycare/dayhome made any special accommodations for your child?*YesNoIf yes, please specify*Final Details:What are you hoping to find in a preschool for your child?*What would you most like to see Montessori & Me accomplish with your child over the next three/four years?*How does your child spend his/her time outside of school (e.g. sports, programs, interests, etc.)?*Do you share our commitment to having your child attend Montessori & Me in their Kindergarten year?*How did you learn about our school:*FriendWebsiteGoogle SearchFacebookApplication Fee Price: $75.00 Please note: Upon submitting the application form there is a $75 non-refundable application fee. This can be sent to us via E-Transfer: casa@montessoriandme.ca or a check to our mailing address: 16018-104 Avenue NW, Edmonton, Alberta T5P0S3Parent Signature*Date* Date Format: MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
