Clear Form
☐ 2019-2020


☐ 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)


☐ M
☐ F


Parent/ Guardian 1

Parent/ Guardian 2


Please list name and location:
Do you or your child have any Montessori experience?
What are your educational goals for your child? How do you see us facilitating these goals?
Please describe your child's educational experience thus far. What has been successful? What has been challenging?
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.
Are there any areas in which we may be able to give special help and encouragement to your child?
List your child's hobbies, sports, or special interests, capabilities or talents?
How much “screen time” does your child have in a typical week?
Does your child play outside on a regular basis?

Please complete this section for children ages 3 and 4

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

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.