210 High Street
Washington, MO. 63090
636-239-5144
Washington Montessori School
210 High Street
Washington, MO 63090
ph: (636)239-5144
fax: (636)239-5858
alt: (636)221-4881
Staff
WashingtonMontessoriSchool
For ages 2 through K
210 High Street
Washington,MO. 63090
(636)239-5144
www.washingtonmissourimontessori.com
Application for Admission
CHILD______________________________________
First Middle Last
Male Female __________________________
Birthdate Age years months
Previous school experience*
___________________________________________
Montessori School Duration
____________________________________________
Other School Duration
I authorize the release of any information from the above school to Washington Montessori School.
Date: _________ Parent Signature __________________
Reason for applying to Washington Montessori:
______________________________________________________________________
_________________________________________________
_______________________________________________________________________________________________________________________________
Mother Father
__________________ ___________________
Mother’s name Father’s name
____________________ ____________________
Home address Home address
____________________ ____________________
Home address Home address
Home Phone______________ Home phone_____________
Mother's Work Father's Work
____________________ ______________________
Business Name Business Name
____________________ ______________________
Business address Business address
Business Phone___________ Business Phone ___________
____________________ _______________________
EMAIL address EMAIL address
Child lives with: both parents, Mother, Father, Other
SIBLINGS GRANDPARENTS
Names and Birthdates Names and Addresses
___________________ _____________________
___________________ _____________________
___________________ _____________________
_________________________________________________________________________________________________________________________
*Washington Montessori School reserves the right of direct access to previous school records and further reserves the right to withhold records of withdrawing students until all accounts due are paid in full.
New Student Profile
In order for us to fully assess the application and to provide the basis for a smooth transition next year, we need you to fill in the following information:
What are your educational goals for your child? How do you see Washington Montessori School facilitation these goals?
_______________________________________________________________________________________________________________
What role can we expect the child’s parent(s)/guardian(s) to play in facilitating the child’s educational goal?
_______________________________________________________________________________________________________________
Does your child have any hobbies, sports, or special interests, or unusual capabilities or talents?
_______________________________________________________________________________________________________________
How do you see your child in his/her social/emotional development?
_______________________________________________________________________________________________________________
Does your child have foreign language education or background? If so, what kind.
_______________________________________________________________________________________________________________
Does your child attend any other schools or special classes? If so, please list. (Music, kumon, etc.)
_______________________________________________________________________________________________________________
Is there any significant medical history about which we should be aware and/or have any diagnostic evaluations (educational or psychological) ever been completed for your child? Please give details. Please request that a copy of educational testing or evaluations be sent to us.
_______________________________________________________________________________________________________________
Are you aware of any areas in which we might be able to give special help and encouragement to your child?
_______________________________________________________________________________________________________________
Does your child follow directions (one-to-one and in a group)?
_______________________________________________________________________________________________________________
What are your child’s responsibilities at home?
_______________________________________________________________________________________________________________
How high can your child count? ________________ Does your child know the sounds of letters? _______________
How much Television does your child watch a day? Which programs does he/she watch?
_______________________________________________________________________________________________________________
Have there been any significant changes in your child’s life in the past year? (Divorce, move, death in the family, etc.) If so, please list.
_______________________________________________________________________________________________________________
Any planned trips? Please list.
_______________________________________________________________________________________________________________
Signature of Parent or Guardian making application
________________________________________ Date ___________________
Please enclose a non-refundable application fee of twenty ($25.00) dollars and return this form to Washington Montessori School.
Winner of "The Best of Washington - Child Care Award"
for 2013-2022!
Washington Montessori School
210 High Street
Washington, MO 63090
ph: (636)239-5144
fax: (636)239-5858
alt: (636)221-4881
Staff