PART 1: CHILD AND FAMILY PROFILE

Thank you for your interest in Montessori Lab School at Grand Center.

To apply, complete this profile (PART 1), short answer questions (PART 2), and submit your application fee of $75 (PART 3).

Desired Date of Admission

YYYY

Programs of Interest

Young Children's Community (15 months-3 years of age)

Children's House (3-6 years of age)

Elementary (6-12 years of age)

Elementary Summer Program (6-12 years of age)

Program Preference

Elementary is a full day program.

Full Day

Half Day

Child Information

Child's Name

First Name

Last Name

Child's Middle Name

Child's Preferred Name

Child's Date of Birth

YYYY

Child's Gender

Parent/Guardian (1) Information

Name of Parent/Guardian

First Name

Last Name

Relationship to Child

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Place of Employment

Business Phone

(###)

###

####

Parent/Guardian (2) Information

Name of Parent/Guardian

First Name

Last Name

Relationship to Child

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Place of Employment

Business Phone

(###)

###

####

Financial Responsibility

Name(s) of individual(s) financially responsible for Child's tuition

Family

Name of Child's Sibling

First Name

Last Name

Sibling's Date of Birth

YYYY

Name of Child's Sibling

First Name

Last Name

Sibling's Date of Birth

YYYY

Name of Child's Sibling

First Name

Last Name

Sibling's Date of Birth

YYYY

Additional Family Member at Home

First Name

Last Name

Relationship to Child

Additional Family Member at Home

First Name

Last Name

Relationship to Child

Language(s) Spoken at Home

School Experience

Name of Previous School (Previous Care Plan if not School)

Dates Attended

Name of Previous School

Dates Attended