Application for Admission

I am applying for the academic year

I wish to enroll my child in the following:

Primary (3-6) Full Day (8am-3pm, M-F) Afternoon Tea & Interesting Things (3pm-4pm, M-F) Maria's Academy (4pm-5pm, M-F) Retreat & Flag Lowering (5pm-5:45pm, M-F)

Stepping Stones (3-year-olds) Mornings (8am-11:30am, M-F) Stepping Stones (3-year-olds) Afternoons (11:30am-3pm)

Explorer Information

First Name:

Middle:

Last Name:

Nickname:

Date of Birth: (mm/dd/yyyy)

Age:

Gender

Male Female

Family Information

PARENT / GUARDIAN

First Name

Last Name

Relationship to the child:

Home Address:

City/Town:

State:

Zip Code:

Phone:

Email:

Please click all that apply:

Admissions Correspondence Decision Responsibility Financial Responsibility Emergency Contact

Would you like to add another parent/guardian?

Yes No

PARENT / GUARDIAN (2)

First Name

Last Name

Relationship to the child:

Address:

Same Address as Above Add New Address

Home Address:

City/Town:

State:

Zip Code:

Phone:

Email:

Please click all that apply:

Admissions Correspondence Decision Responsibility Financial Responsibility Emergency Contact

Would you like to add another parent/guardian?

Yes No

PARENT / GUARDIAN (3)

First Name

Last Name

Relationship to the child:

Address:

Same Address as Above Add New Address

Home Address:

City/Town:

State:

Zip Code:

Phone:

Email:

Please click all that apply:

Admissions Correspondence Decision Responsibility Financial Responsibility Emergency Contact

Would you like to add another parent/guardian?

Yes No

PARENT / GUARDIAN (4)

First Name

Last Name

Relationship to the child:

Address:

Same Address as Above Add New Address

Home Address:

City/Town:

State:

Zip Code:

Phone:

Email:

Please click all that apply:

Admissions Correspondence Decision Responsibility Financial Responsibility Emergency Contact

Would you like to add another parent/guardian?

Yes No

PARENT / GUARDIAN (5)

First Name

Last Name

Relationship to the child:

Address:

Same Address as Above Add New Address

Home Address:

City/Town:

State:

Zip Code:

Phone:

Email:

Please click all that apply:

Admissions Correspondence Decision Responsibility Financial Responsibility Emergency Contact

Additional Information

Please Select:

This is my child's first experience with non-familial caregivers My child has had the following experience with non-familial care

Please describe your child's past experience:

Have you applied to Maria's House Montessori previously?

Yes No

Have any family members attended a Montessori program?

Yes No

Does your child have any medical or emotional issues that may require special attention?

Yes No

If yes, please describe briefly:

Briefly describe your child.

We know this is a challenge. Just write the first few things that come to mind.

Tell us more:

Please list anything else you might like us to know about your child or your family.

To complete your application, please read the following carefully, review your information, sign this page and submit this form with your non-refundable application fee of $50.00.

I/We certify that the information in this application is true, accurate and complete. I/We authorize Maria's House Montessori to request any information relevant to this application. I/We understand that any recommendation received on behalf of our child or family shall remain confidential. I /We understand that false, incomplete, omitted or misleading information given on this application or during the application admitted to the Primary Program at Maria's House, enrollment will be contingent upon the receipt of a signed agreement and deposit within ten days of our notification.

Signatures:

Parent/Guardian Acknowledgment (electronic signature)

By checking the box below you agree that the information in this form is true to the best of your knowledge, and that it is your intention to apply on behalf of your child to the Primary Program at Maria's House Montessori.

I agree

Maria's House Montessori welcomes students of any race, color, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the school. We do not discriminate on the basis of race, color, national or ethnic origin, or any other protected class in administration of our educational policies, admissions policies, or any other Maria's House programs or offerings.

Amount Due:

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