MONTESSORI AT THE OLD SCHOOLHOUSE
557 West Kerley Corners Road, Tivoli, NY 12583
PRIMARY APPLICATION FORM
|Is child adopted?||Yes No||If yes, does the child know?||_______________|
PARENTS / GUARDIANS
|Parent 1:||_______________________||Parent 2:||_______________________|
With whom does child reside? _________________________
Who is financially responsible for the child’s tuition? _________________________
Are there any other adults living with child? ____________________________
Any pets at home? _______________________
|Name||Date of Birth||Gender|
SCHOOLING / CHILDCARE
Previous school/ childcare situation:
Reason for leaving:
How did you learn about Montessori at the Old Schoolhouse?
What made you choose a Montessori program?
What do you expect to receive from a Montessori Program?
|Is your child toilet trained?||Yes No|
|What words are used for bathrooming?||____________________________________|
|When did your child start to walk?||____________________________________|
|Did she/he crawl?||____________________________________|
Please list your child’s strengths, interests and talents?
Please describe your child’s personality and temperament?
Please check any that apply to your child:
◻ Shyness◻ Fearfulness◻ Thumb sucking / Pacifier / Bottle
|◻ Easily upset||◻ Shyness||◻ Other:|
Please feel free to share any additional information you would like us to know about your child or your family (e.g. any areas needing special attention, goals for your child at school, etc):
Has your child had any serious illness, operations, or accidents (including any complications at birth, allergies, etc)? If yes, please specify?
Has your child had any recent changes (e.g. change in residence, new baby, family illness or death of a loved one or pet)?
PROGRAMS & TUITION
Please rank your choice of program (1st, 2nd, and 3rd):
____ 5 days a week *
____ 4 days a week (Monday, Tuesday, Thursday, Friday)
____ 3 days a week (Monday, Tuesday, Wednesday)
____ 3 days a week (Wednesday, Thursday, Friday)
Please note: No substitutions of days without prior approval
* Kindergarten children must attend five days a week
5 days/week – $4100.00 ($410.00 / 10 installments)
4 days/week – $3700.00 ($370.00 / 10 installments)
3 days/ week – $ 3170.00 ($317.00 / 10 installments)
Toddler Tuition (or any child still in diapers in primary classroom):
5 days / week – $ 4510.00 ($451.00 / 10 installments)
4 days / week – $ 4050.00 ($405.00 / 10 installments)
3 days / week – $ 3520.00 ($ 352.00 / 10 installments)
Thank you for taking the time to fill out this application as completely as possible. The information contained in it will be kept confidential. Please return this form with a nonrefundable application fee of $50.00. We must receive both the completed form and the fee before your child can be considered for placement in our program. If we are able to offer your child a place at Montessori at the Old Schoolhouse, we will contact you to begin the enrollment process.
Montessori at the Old Schoolhouse does not discriminate based on race, religion, sex, color, creed, national or ethnic origin.