Pre-K / Kindergarten Application - Growing Minds Montessori School

Select Program

Student's Full Name Name

First Middle Last

Name Used / Nickname

Gender

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Date of Birth

Age in September

Present School

Present Grade

Number of Years in System

Start Date

Is another child in your family applying?

Yes
No

Mother's Info

Mother's Name*

First Last

Mother's Email*

Mother's Phone

Mother's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mother's Occupation

Father's Info

Father's Name

First Last

Father's Email

Father's Phone

Is the Father's address different?

Yes
No

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Father's Occupation

Physician Info

Physician's Name

First Last

Physician's Phone

Physician's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

May the school call another physician if unable to contact the above?

Yes
No

Emergency Contact Info

Other person to be notified in case of illness or accident:

Name

First Last

Relationship

Phone

People permitted to pick up the child

Mother

Yes
No

Father

Yes
No

Other people permitted to pick up the child:

Name

First Last

Relationship

Phone

Name

First Last

Relationship

Phone

Additional Info

Does your child have any difficulties with:

Eyes
Ears
Speech

Are there any conditions in the family that might affect the adjustment of the child?

Name and ages of siblings or other members in the family:

Special instructions or areas of concern:

Are you interested in joining a parent car pool?

Yes
No

Do we have permission to publish your name, address and telephone number in our school directory?

Yes
No

Are you interested in being a parent volunteer?

Yes
No

In what areas?

Signature

Date

For new students, this form must accompany a non refundable fee of $100. Applications are served on first come first save basis

Name

This field is for validation purposes and should be left unchanged.