ࡱ> I   !"#$%&'()*+,-./013456789:;<=>?@ABCDEFGHRoot EntryZ O2deJCONTENTS ^Object 2YnL -ddContents2a,______________________ Cellular Phone :(____)________________________________________ Marital Status: __Married __Divorced __Separated __Widowed __Single __Remarried __Step-Parent __Guardian Siblings: Name_________________________________Age____Name_____________________________Age_______ Child resides permanently with:_______________________________________________________________________ Person responsible for tuition payment:_________________________________________________________________ Persons permitted to remove child from school: Legal Custody: Mother __Yes __No __Yes __No Father __Yes __No __Yes __No Guardian __Yes __No __Yes __No Other persons authorized by the parents or guardians to take the child from the school: Name:_______________________________________________________ Phone: (____)________________________ Address:__________________________________________________ Relationship:____________________________ Name:_______________________________________________________ Phone: (____)________________________ Address:__________________________________________________ Relationship:____________________________ Child s Physician: _______________________________________________ Phone: (____)_______________________ Address:__________________________________________________________________________________________ May the school contact another physician if unable to contact the above? __Yes __No Persons to be contacted in case of illness, accident, or emergency, if for some reason the parents or guardians cannot be contacted: Name:_____________________________________________________ Phone: (____)___________________________ Address:________________________________________________ Relationship:______________________CHNKWKS ^\TEXTTEXT0FDPPFDPP4FDPPFDPP6FDPCFDPC8FDPCFDPC:FDPCFDPC<FDPCFDPC>FDPCFDPC@FDPCFDPCBFDPCFDPCDFDPCFDPCFFDPCFDPCHFDPC FDPCJFDPC FDPCLSTSHSTSHNSTSHSTSHN2SYIDSYIDPNSGP SGP dNINK INK hNe____Name___ ________________________________________________________________________________ Application for Student Admission Child s Name: ____________________________________________________________________________________ (Last) (First) (Middle) ___Male ___Female Birth date:____/____/____ Anticipated Enrollment Date: ____/____/____ SSN:___________________________________ Ethnicity:________________________________________________ Mother s Name:_______________________ SSN: ____________________Driver License #:_____________________ Home Address:__________________________________________ Home Phone: (____)________________________ City: ______________________________________ ST: _______________ Zip Code:___________________________ Occupation:____________________ ______________Employer:____________________________________________ Business Address: ______________________________ Business Phone:(____)_________________ext.____________ Email_____________________________________ Cellular Phone:(____)_____________________________________ Marital Status: __Married __Divorced __Separated __Widowed __Single __Remarried __Step-Parent __Guardian Father s Name:______________________ SSN: ____________________ Driver License #:_______________________ Home Address:__________________________________________ Home Phone: (____)_________________________ City: _______________________________________ ST: ______________ Zip Code:___________________________ Occupation:__________________________________ Employer:____________________________________________ Business Address: ________________________________ Business Phone:(____)_______________ext.____________ Email:____________________ Special instructions regarding medical conditions, eating habits, toilet training, or other areas of concern: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What is the primary language spoken in your home? ______________________________________________________ What is the child s primary language?___________________________________________________________________ What language would you prefer as your child s primary language? ___________________________________________ Child s hobbies/interests/extracurricular activities:_________________________________________________________ _________________________________________________________________________________________________ How did you learn about Montessori Children s Academy? __Referral - by whom? __________________________ Advertisement -where?____________________________ __Other __________________________________________________________________________________________ Please indicate your registration preferences. I would like my child to attend Montessori Children s Academy and to complete: __Infant __Toddler __Pre-Primary __Elementary Montessori (3 to 18 months) (1 to 2 year old) (3 to 6 year old) (K to 5th grade) __Full Day (8:30 AM - 3:00 PM) $650 __Half Day (8:30 AM - 12:00 PM) $550 __Full Day Toddler $650 __Half Day Toddler $550 __Before School Care (7:00 - 8:00AM, $2.00 per day) __Extended School Care (3:30 - 6:00 PM $6 per day.) __Unlimited Before & Extended Care ( $80/mo. pre-paid) __Catered Lunch ($80.00 a month) __Dance __ Karate ($60.00 a month, 2 times per week) __Summer Program The tuition is $6,500.00/Yr. For those parents who prefer a monthly payment, the tuition will be divided in Ten monthly payments of $650.00/Month, (Aug - May) for your convenience. I have read the application form, school policies and tuition schedule and agree to the terms outlined therein. Parent s Signature: ______________________________________________ Date:_________________________ Montessori Children s Academy admits students without regard to race, religion, sex or national origin. _______________ What language would you prefer as your child s primary language? ___________________________________________ Child s hobbies/interests/extracurr'tv@Bj :  z FJhV\&(tTT((T&2'(  D)4","PS2'(  D)4" 2'(  D)0"PS2$'(  D) R4R 2'(  z&2'(  z4" 4")tvH:! ""##$$^%%&b'd'''b(d()**T+X++,-.>0@0"1$111222hhddddddddddddZZZZ6(2"'( ) @S $2'(  D) "PS&2'(  D)4","PS2'(  D)4" 2'(  D)&"PS2'(  D)L2" $  08."4 " $  08."2 "PS" $  084 "0" $  084 "0" $  084 "PS" $  08 " " >B t" $h (08@HPX`hpxz" $h (08@HPX`hpx."z" $h (08@HPX`hpx."B\& * > "z" $h (08@HPX`hpx."z" $h (08@HPX`hpx."t" $h (08@HPX`hpxv " $h (08@HPX`hpx> B V Z p t        t" $h (08@HPX`hpxz" $h (08@HPX`hpx."z" $h (08@HPX`hpx." 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