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Online Application

I. PRIMARY INFORMATION

Student’s Name:
First: Middle: Last:

Student's Date of Birth (mm/dd/yyyy):    Gender:    State or Country of Birth:

Primary Language:    Secondary Language?

Primary Address:
Street:    City:    Zip:

II. CONTACT INFORMATION

Mother/Legal Guardian:    Primary Phone:    Alternate:

E-mail address:    Occupation and Title:

Employer:    Work Hours:    Phone:

Father/Legal Guardian:    Primary Phone:    Alternate:

E-mail address:    Occupation and Title:

Employer:    Work Hours:    Phone:

Emergency Contact:    Primary Phone:    Alternate:

III. FAMILY INFORMATION

Child resides with:    Parents are:

If the parents are separated or divorced, please advise:

Legal custodian:    To whom should we send correspondence?

Who is financially responsible for this child?

Secondary Address:
Street:    City:    Zip:

Please list all siblings’ names and dates of birth:

Student’s ethnicity: (Optional, but we would love to keep historical track of the diversity of our school)

If multiracial, please specify ethnic groups:

IV. Education History

Current School:    Phone:

Address:
Street:    City:    Zip:

Please list the names and dates of previous schools your child has attended, back to age 2.

Name:    Dates:

Name:    Dates:

V. ENROLLMENT COMMITMENTS

Should you enroll your child in Village Montessori as of September 2013, you will be asked to read through and complete our Parent Commitment Form (available as pages 3-4 of the downloadable application).

By clicking submit I assert that the information provided on this application is true and accurate to the best of my knowledge.

Parent/Legal Guardian:    Parent/Legal Guardian:

Date(mm/dd/yyyy):

NOTE: A $50 non-refundable application fee must accompany each application and can be mailed to, or dropped off at, the school's physical address.