| Child's Information |
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* Child's First Name:
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Middle Name:
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* Last Name:
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* Birthday (mm/dd/yyyy):
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* Address:
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* City:
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* Province:
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* Postal Code:
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* Child's First Language?
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What language is spoken at home?:
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| Parent/Guardian Information |
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Parent/Guardian 1
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Parent/Guardian 2
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Name
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Telephone
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Business
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Cell
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Fax
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Occupation
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* Email
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Parental Status:
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Child Resides with:
Both Parents
Parent/Guardian 1
Parent/Guardian 2
Grandparents
Other (Please specify):
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Is your child adopted?
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If yes, does he/she know?
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Please list the names and ages of sibilings in your home:
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| Financial Responsibility for the student's tuition will be assumed by: |
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* First Name:
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Last Name:
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Phone:
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| Current Preschool or Daycare Information |
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Present Preschool or Daycare:
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Preschool Phone:
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Director Name:
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Emergency/Medical Information |
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Contact Name:
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Contact Phone:
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Family Physician:
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Physician Phone:
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Are there any medical or emotional concerns the school should be made aware of? If yes, please detail:
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Are your child's immunizations up-to-date?
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Does your child have any known physical limitations or allergies? If yes, please describe:
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Is your child on medication? If yes, please detail:
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Has your child had any specialized evaluations or received any counselling or therapy? If yes, please describe:
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Does your child have any special needs? If yes, please detail:
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Has your child's present school made any special accommodations for your child? If yes, please describe:
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Has your child ever suffered any serious illness, injury or hospitalization? If yes, please describe:
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Is your child frightened of anything we should be aware of?
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Does your child still nap? If so, at what time:
No
Yes (Time:)
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When was your child potty trained (age in months)?
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Are there any dietary restrictions your child must follow? If yes, describe in detail:
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| Final Details |
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What are you hoping to find in a school for your child?
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What would you most like to see Montessori & Me accomplish with your child over the next few years?
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How does your child spend his/her time outside of school? (e.g. sports, other programs, interests, etc.):
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Do you share our commitment to the three-year Montessori Program?
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How did you learn about our school?
Website
Print Ad
From a Friend
Other (Please Specify):
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Preferred program time:
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Projected entry date:
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