Child's Name:

Applying for Academic Year: 2008-2009 2009-2010 2010-2011

Pre-School
Full Day (8:30 - 3:00 M thru F) $735
Five Mornings (8:30 - 12:00 M, W, F) $525
Three Mornings (8:30 - 12:00 M, W, F) $385
Two Mornings (8:30 - 12:00 T, Th) $275

Kindergarten- 1st Grade Combination Class
Full Day (8:30 - 3:00 M thru F) $735

After School Enrichment - Peaceful Play (more info)
Available M thru F (3:00 - 6:00) $10 per day.

Child's Age Birthdate Gender

Address

City

State Zip Telephone #('s)

Person Responsible for Payment of Tuition:

Name

Telephone #('s)

Mother's Information:

Mother's Name

Mother's Home Address

Telephone #('s)

Occupation Company

WorkAddress

Work Phone E-mail address

Special Interests/Talents

Father's Information:

Father's Name

Father's Home Address

Telephone #('s)

Occupation Company

WorkAddress

Work Phone E-mail address

Special Interests/Talents

Brothers and Sisters (Please enter their name, age, gender and current school)

Medical and Health Information

Pediatrician

Phone

Dentist

Phone

In case of illness or emergency, whom should we contact if we cannot reach family members?

Name

Relation to Child

Home Phone Work Phone

Anything unusual about the child’s birth, development, or medical condition that we should be aware of?



General Health (recent immunization record must be submitted)



Allergies (known or suspected)



Medication (type and reason)



Is your child toilet trained? Yes No

To what extent?

Does your child sleep well? Yes No

Nap? Yes No

When?

What type(s) of discipline have you found to be the most effective with your child?

Why are you interested in enrolling your child in West Orange Montessori School?

What do you hope your child will gain or learn from his or her experience here?

Your Name

Date

A non-refundable application fee of $75 will secure your child’s place in the program of your choice.