August 26, 2015

APPLICATION

 MONTESSORI SCHOOL ST. CLAIR

2360 Country Road  Belleville IL 6222

APPLICATION FORM

       montessorischoolst.clair@gmail.com

618-235-4289

APPLICATION IS FOR ___________________________________                DATE OF BIRTH _________SEX ________ TELEPHONE __________

HOME ADDRESS ______________________________________________________CITY __________________STATE _________ ZIP _____________

PARENT/GUARDIAN #1 NAME_________________________________________________RELATIONSHIP TO STUDENT_____________OCCUPATION____________

CELL PHONE____________EMAIL ADDRESS___________________

PARENT/GUARDIAN #2 NAME________________________________________________RELATIONSHIP TO STUDENT________OCCUPATION_________

CELL PHONE_____________EMAIL ADDRESS_________________

DESIRED ENTRANCE DATE ___________________________________________________

HAS YOUR CHILD HAD PREVIOUS SCHOOL EXPERIENCE (please describe)____________________________________________________________________________

Is your child’s Immunized?_______________

How did you hear about our school?_______________________                             Who may we thank for referring you?__________________________

Please return this application accompanied by cash or a check for $25 payable to Montessori School St. Clair. This is a non-refundable application fee.

SIGNATURE PARENT/GUARDIAN #1 ________________________DATE __________________

SIGNATURE PARENT/GUARDIAN #2 ___________________________DATE _______________