Application Child's Name: Gender: Birth date: Address: Parent 1 Name: Parent 1 Address: Parent 1 Phone: Parent 1 Email: Parent 1 Occupation: Parent 2 Name: Parent 2 Address: Parent 2 Phone: Parent 2 Email: Parent 2 Occupation: Please select one program for which you are applying: —Please choose an option—Full DayMornings Please select your preferred days: MondayTuesdayWednesdayThursdayFriday Would you be enrolling in Aftercare from 3:00pm-4:30pm? —Please choose an option—YesNo Is your child using the toilet independently? —Please choose an option—YesNo If not, where are they with toilet learning? Does your child currently attend a program? —Please choose an option—YesNo If so, where? What days/hours? Does your child have medical health insurance? —Please choose an option—YesNo Why are you choosing a Montessori program for your child: Do you plan on enrolling your child until they attend kindergarten or first grade? —Please choose an option—YesNoNot sure yet Where did you hear about us: Any additional information you would like to share: