Clear Form
☐ 2020-21
Program is 5-day (Mon - Fri), and run on the academic year as determined by JCPS.
☐ Full Day (8:00a-3:25p)

Child

☐ M
☐ F
☐ Non-Binary

Parent / Guardian 1

Please write the street address of the child's main residence

Parent / Guardian 2

Our Commitment to Equity

In line with Wildflower’s equity principle, it is important for us to understand the backgrounds of the families we seek to serve.

We use this information in aggregate to open new Wildflower schools in underserved communities, raise money to support schools and reflect on our progress to serve a diverse community.

Please share as openly as you are comfortable, for the home that the child spends the majority of their time in. Thank you.

What is the language most often spoken in your household? If none of the options below are descriptive, please select "other" for a freeform option.
☐ Arabic
☐ Armenian
☐ Bantu (Including Swahili)
☐ Begali
☐ Burmese
☐ Cantonese
☐ English
☐ French
☐ German
☐ Greek
☐ Gujarati
☐ Haitian - Creole
☐ Hebrew
☐ Hindi
☐ Hmong
☐ Italian
☐ Japanese
☐ Karen
☐ Khmer
☐ Korean
☐ Mandarin
☐ Navajo
☐ Persian (including Farsi and Dari)
☐ Polish
☐ Portuguese
☐ Punjabi
☐ Russian
☐ Serbo-Croatian (including Bosnian, Croatian, Montenegrin and Serbian)
☐ Spanish
☐ Tagalog
☐ Tai-Kadai (including Thai and Lao)
☐ Tami
☐ Telugu
☐ Urdu
☐ Vietnamese
☐ Other:
Select one or more of the options below which you feel best describe your child. If none of the options below are descriptive, please select "other" for a freeform option.
Answer YES, if your yearly household income is below these numbers:
Household Size2345678
Annual Income Threshold$31,894$40,182$48,470$56,758$65,046$73,334$81,622
For each additional family member, add $8,288.

Getting to know you.

Please list every school that your child has attended OR are considering now.
Please tell us about the child’s regular adult caregivers, including parents. For each adult, include the name, relationship to the child, and current employment. Please complete for each adult who regularly cares for your child in your home or theirs.
What are your educational goals for your child? How do you see us facilitating these goals?
What role can we expect the child's parent(s)/guardian(s) to play in facilitating this child's educational goals?
How do you see your child in their social and emotional development?
Please describe your child's group care experience thus far. What has been successful? What has been challenging?
Has your child any indicators of a developmental delay, either brought up by a pediatrician, or by yourself? Please explain.
Does your child have specific special needs (educational, medical, or psychological)? Has your child received any testing or evaluations that would relate to their developmental or social performance? Please have copies sent of tests or evaluations that your child has taken. We request this information so as to determine how we might best serve your child.
Are there any areas in which we may be able to give special help and encouragement to your child?

About Your Child

What is your child’s temperament and learning style? What five words would you use to describe your child?
How does your child adjust to new settings and situations? How quickly or slowly does your child acclimate to new environments?
If co-parenting, please describe your similarities and differences.
Please include morning, nap time, meals, and bed time routines.
Why have you chosen Magnolia Montessori as a possible match for your family?
If you have any previous Montessori experience please describe it.
Do you anticipate any challenges to this level of involvement in the school?