CHILDREN’S MONTESSORI SCHOOL
Peru, Illinois
ADMISSION APPLICATION

Application is hereby made for ______________________________________________

(last name) (first)

Age__________Date of Birth__________________________ ___Female ___Male

Address_________________________________________________________________

Street City Zip

Tel__________________Mobile phone______________________Beeper____________

Father’s Name__________________________Occupation________________________

Employer _________________________________Tel._____________________

Business Address___________________________________________________

Mother’s Name__________________________Occupation_______________________

Employer________________________________Tel.______________________

Business Address___________________________________________________

Names and Ages of Siblings_________________________________________________

Program Desired:___ Preschool A.M ____Preschool P.M. ____Preschool Full Day

___ Kindergarten ____Elementary ____Preschool 3 Day P.M.

Extended Care ____ Before School ____After School ____Both

Payment Schedule: ____Year ____Semester ____Monthly

Has your child had previous preschool or daycare experience? ___________

If yes, please describe_______________________________________________________

How did you learn about our school?____________________________________________

Why do you wish your child to be enrolled in a Montessori environment? ________________________________________________________________________

________________________________________________________________________

Describe Your Child (temperament, special problems, toilet trained, etc.)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Signed by Parent or Guardian__________________________________________________

Date:_____________________

Desired Date of Entrance:_____________________________________________________

------------------------------------------------------------------------------------------------

Do not write in this space Date received _________________ Enrollment fee received________ Check Number___________________ Starting Date_________________

Return this Application with a $50.00 non-refundable application fee to: Deb Selner, Administrator Children’s Montessori School, Inc. 2218 Marquette Road Peru, IL 61354

Children’s Montessori School does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admission policies and any school-administered programs.