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.

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.