Clear Form
☐ 2020-2021

Toddler Program (14 months – 2 years old)
4 or 5 days
Half Day: 9 am – 12:15 pm
Full Day: 9 am – 2:45 pm

Primary Program (3 – 4 years old)
5 days
Half Day: 8:30 am – 12:15 pm
Full Day: 8:30 am – 2:45 pm

☐ Primary: Half Day
☐ Primary: Full Day
☐ Toddler: Half Day
☐ Toddler: Full Day
☐ Elementary
☐ Kindergarten
Only Toddlers may attend 4 days. All other must attend 5 days.


☐ English
☐ Hebrew
☐ Spanish
☐ French
☐ Portuguese
☐ Other:
☐ M
☐ F

Mother / Guardian

(Mrs., Ms., Dr., etc.)

Father / Guardian

(Mr., Dr., etc.)

About Your Family

Please list name(s) and relation to child
Joint custody arrangements? Does child have contact with both parents?
Please list the names, ages, and what school they attend.
i.e. divorce or separation between parents, illnesses, hospitalizations, birth of a sibling, death in the family, moves, etc.

About Your Child

Please list every school, daycare, or program that your child has attended and the dates they were at each one.
School NameDates They AttendedWhy Did They Leave?
What are your educational goals for your child?
What role can we expect the child's parent(s)/guardian(s) to play in facilitating this child's educational goals?
What role can we expect the child's parent(s)/guardian(s) to play in facilitating this child's educational goals?
Do they nap? When do they nap/wake up? Do they have a special routine?
Does your child co-sleep? What time do they go to bed/wake up? Do they get up in the night?
Please check the answer that best applies to your child at the present time.
How have you gone about toilet training? Does your child need reminders? Do they have any special routines/words around using the toilet?
Would you classify them as a picky eater, adventurous, etc.? What are some of their favorite foods?
Check all that apply.
Check all that apply.
Does your child have any hobbies, sports, or special interests, capabilities or talents?
Does your child view screens/watch television? What types of things do they watch? What time of day usually and how often?
i.e. loud noises, clowns, the dark, etc.
If yes, please describe:
i.e. food/hungry, bathroom/potty, or water/thirsty, etc.
Please list any specific Montessori books or materials you have read
How do you see your child in their social and emotional development?
Please describe your child's educational experience thus far. What has been successful? What has been challenging?
Has your child had any remedial work, special tutoring, or enlightenment classes in the past two years? Please explain.
What are your child's strengths?
Are there any areas in which we may be able to give special help and encouragement to your child?
Does your child have any developmental concerns? If so, please describe.
Were any recommendations made for your child? (Please tell us, even if you chose to not follow them)

Please provide the office with any evaluations, reports, assessments, IFSPs, or IEPs

Financial Aid Application

If you wish to apply for financial aid, please complete the information below, fill out this form, and provide the office with your 2 most recent pay stubs or a copy of the first page of your most recent tax return. If there are any extenuating circumstances that you would like us to be aware of please provide us with a letter of explanation.

Non-Discrimination Policy

We value diversity among our students. We do not discriminate in our enrollment policies on the basis of race, color, gender, religion, sexual orientation, national or ethnic origin.

Upon completion of this form, please submit your $85 Application Fee.