Clear Form
☐ 2021-2022


☐ 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

This list is a private list, only visible to KMS admin, and not shared.

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, 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.

Immunization Policy

KMS supports the position of Maine State Law that vaccines are a safe and inexpensive way to provide protection against certain diseases. Under the law, no child is permitted to attend school without a certificate of immunization for each disease, or other acceptable evidence of required immunization or immunity against each disease. All children must present an immunization record signed by a physician, nurse or other person who gave the vaccine by the beginning of the school year.

Parents who decline immunization due to medical or religious/philosophical reasons must complete the required Immunization Exemption Form, available at the school office. Only medical exemptions will be accepted as of 2021, per Maine law. If you have questions about this, please contact the Head of School.

Please be aware that, if one of the diseases for which immunization is required is identified in the school, we are required to exclude non-immunized children from school.

Students still not immunized (or exempted) by September 15 will not be able to attend school until the immunization requirements are met.

I agree to provide an up to date immunization record or an exemption form by September 15, 2021.