The Montessori Country School Application

Session*

Program Option*

☐ Toddler: Half Day

☐ Toddler: Full Day

☐ Casa: Full Day

☐ Lower Elementary (Grades 1 - 3)

☐ Upper Elementary (Grades 4 - 6)

☐ Virtual Toddler

☐ Virtual Casa

☐ Virtual Elementary

Requested Start Date*

Child Name *

Birthday*

Child Gender

Name *

Address*

Home Number*

Mobile Number*

Parent1 Email*

Name *

Address*

Home Number*

Mobile Number*

Parent2 Email*

How did you hear about us?

Siblings

Previous Schools or Child Care CentresPlease list any schools or child care centres your child has previously attended

Educational GoalsWhat are your educational goals for your child? How do you see us facilitating these goals?

Social/Emotional/Language DevelopmentHow do you see your child in their social, emotional and language development?

Allergies and/or Food RestrictionsDoes your child have any allergies or food restrictions? Do they require any medication for these?

Special Needs and/or Medical ConditionsDoes your child have any special needs (educational, medical, or psychological)? Has your child received any testing or evaluations that would relate to their academic or social performance?

How do you prefer to be contacted?*

Phone

Email

The Montessori Country School Application

Child

Parent / Guardian 1

Parent / Guardian 2

Background information