August 26, 2015

APPLICATION

MONTESSORI SCHOOL ST. CLAIR

2360 Country Road,  Belleville IL 62221

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?_______________

Does your child display any mental, physical or behavioral issues that we may need to be aware of:_______________________________________________________

What is your child’s prior school or Day Care experience? ___________________________

How did you hear about our school?_______________________

Who may we thank for referring you?__________________________

Please return this application fee  accompanied by  a check for $25.00 payable to Montessori School St. Clair. This is a non-refundable application fee.

SIGNATURE PARENT/GUARDIAN #1 ____________________DATE __________________

SIGNATURE PARENT/GUARDIAN #2 ____________________DATE __________________