Please , fill it out and bring it in or mail it.

MONTESSORI AT THE OLD SCHOOLHOUSE

557 West Kerley Corners Road, Tivoli, NY 12583

TODDLER APPLICATION FORM

Child’s Name: ________________________________
Birth Date: ________________________________
Nickname: ________________________________
Gender: Female     Male
Address: ____________________________________________________
Phone: ________________________________
Birthplace: ________________________________
Allergies: ________________________________
Is child adopted? Yes   No    If yes, does the child know? _______________

PARENTS / GUARDIANS

Parent 1: _______________________ Parent 2: _______________________
Relationship: _______________________ Relationship: _______________________
Phone: _______________________ Phone: _______________________
Email: _______________________ Email: _______________________
Occupation: _______________________ Occupation: _______________________
Hours: _______________________ Hours: _______________________

With whom does child reside? _________________________

Who is financially responsible for the child’s tuition? _________________________

Emergency Contact: ____________________________________
Phone: ____________________________________

FAMILY LIFE

Are there any other adults living with child? ____________________________

Any pets at home? _______________________

Siblings:

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?
________________________________________________________________

CHILD BACKGROUND

Did your child crawl? _______________________________
When did your child start to crawl? _______________________________
What words does your child use for food? _______________________________
Other words that would be helpful to know about? _______________________________

Please list your child’s strengths, interests and talents?
________________________________________________________________

Please describe your child’s personality and temperament?
________________________________________________________________

How do you calm your child down when she/he is upset?
________________________________________________________________

Please check any that apply to your child:

◻ Shyness◻ Fearfulness◻ Thumb sucking / Pacifier / Bottle

◻ Easily upset ◻ Shyness ◻ Tantrums ◻ 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

Toddler Tuition:
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.

Signature: ______________________________
Date: ______________________________

Montessori at the Old Schoolhouse does not discriminate based on race, religion, sex, color, creed, national or ethnic origin.

Please , fill it out and bring it or mail it.