|
please return with $25 application fee and $100 material fee
bitte reichen Sie Ihre Anmeldung mit $25 USD Anmeldegebühr und $100 Materialgebühr ein
Sollten Sie Fragen haben, rufen Sie uns an: 001-423-479-7282 oder emailen Sie uns: info @ montessorikinder.com
Wir freuen uns Ihnen behilflich zu sein!
limited for school year 2011/2012
Entry date: _________________
Todays date: _______________
Child’s Full Name: _______________ __________________ _______________
Birth date: _________________ Current Age: _______________ Gender: ________
Residence: _________________ _____________________ _________
Social security number: __________________ Health care/insurance: ______________
Birthmarks/allergies/other pertinent information: _______________________________ ________________________________________________________________
Child resides with:________________________________________________________
Previous Schools attended:
____________________________ ____________________
name of school and city dates
____________________________ ____________________
name of school and city dates
EMERGENCY CONTACT:
__________________________ _______________
name phone number
Physician’s name: _________________________________
Address: ________________________________________
Office phone number: _____________________________
Siblings: Name: __________________ Gender: ___________ Birthdate: __________
Name: __________________ Gender: ___________ Birthdate:__________
Mother’s Full Name: __________________ ________________
Residence: _______________ _________________ ___________
Phone numbers: ____________________ ________________ ________________
Email: _____________________________________
Occupation: ________________ Business/Name of Company: ________________
Father’s Full Name: __________________ ________________
Residence: _______________ _________________ ___________
Phone numbers: ____________________ ________________ _________________
Email: _____________________________________
Occupation: ________________ Business/Name of Company: ________________
Name of persons authorized to pick up child:
>No child will be permitted to leave the school with anyone
(except mother and father as met in person) without a written permission from parent<
1. Name: _____________________________________________
Residence: _________________________________________
Phone number: ______________________________________
Relationship to child: _________________________________
Driver’s Licence number: _____________________________
2. Name: _____________________________________________
Residence: _________________________________________
Phone number: _____________________________________
Relationship to child: ________________________________
Driver’s Licence number: _____________________________
How did you hear about Montessori Kinder? __________________________________
Date: ______________________ Signature: ______________________
|
