APPLICATION FOR ADMISSION

Clear Form

Session*

2019-20

MONTESSORI PROGRAMS

Which Program Are You Interested In:

☐ Primary Mornings (3 or 5-day/week from 8:30 to 11:30 for ages 3 and 4)

☐ Full Day Montessori (3 or 5-day/week from 8:30 to 2:30 for ages 3 and 4)

☐ Extended Day (5-day/week from 8:30 to 2:30 for age 5 as of Oct. 15)

☐ Elementary (5-day/week from 8:30 to 3:00 for ages 6 to 12)

CHILD:

Child Name *

Birthday*

Child Gender

PARENTS/GUARDIANS:

Parent/ Guardian 1

Parent/Guardian 1 Name *

Parent/Guardian 1 Address*

Home Number

Mobile Number

Work Number

Parent/Guardian 1 Email*

Parent/ Guardian 2

Parent/Guardian 2 Name *

Parent/Guardian 2 Address*

Home Number

Mobile Number

Work Number

Parent/Guardian 2 Email*

BACKGROUND INFORMATION:

Does Your Child Have Previous School Or Daycare Experience?

YesNo

Previous Schools/Daycares

Please list name and location:

Montessori Experience*

Do you or your child have any Montessori experience?

Educational Goals

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

Educational Experience (For Elementary Children)

Please describe your child's educational experience thus far. What has been successful? What has been challenging?

Special Needs

Does 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? Please have copies sent of tests or evaluations that your child has taken.

Special Help And Encouragement

Are there any areas in which we may be able to give special help and encouragement to your child?

Hobbies And Interests

List your child's hobbies, sports, or special interests, capabilities or talents?

Tv/Computer Use

How much “screen time” does your child have in a typical week?

Outside Play

Does your child play outside on a regular basis?

Please complete this section for children ages 3 and 4

Does Your Child Use The Bathroom Independently?

YesNo

Does Your Child Follow Basic/Simple Directions?

YesNo

How Do You Respond If Or When S/He Does Not?

How Do You Comfort Your Child?

Is Your Child In The Habit Of Taking A Nap? When?

Social Development

Do you have any concerns about your child’s development?

Toileting

Separation from Parents

Ability to Participate in Group Activities (i.e. circle)

Verbal Skills (ability to communicate needs)

Social Interaction with Peers/Teachers

Sensory Issues

Elaborate As Needed

Is There Anything Else That You Feel Is Important For The School To Be Aware Of?

Siblings

Name	Date of Birth

How did you hear about us?

Statement of Non-discrimination

The Kennebec Montessori School is an equal opportunity program and does not discriminate on the basis of race, color, gender or gender expression, religion, national or ethnic origin, disability, marital status, or sexual orientation in administration of its educational, admissions, or hiring policies.