Child's Name

First Name

Last Name

Date of Birth

YYYY

Place of Birth

Eye Color

Hair Color

Height

Weight

Identifying Marks

Primary Language

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Mother's Name

First Name

Last Name

Mother's Cell Phone

(###)

###

####

Mother's Email

Mother's Company Name and Occupation

Mother's Work Number

(###)

###

####

Father's Name

First Name

Last Name

Father's Cell Phone

(###)

###

####

Father's Email

Father's Company Name and Occupation

Father's Work Number

(###)

###

####

Names of siblings including Sex, DOB, Grade and School

Why do you wish to send your child to a Montessori School?

Do you have any friends with children in a Montessori School? If so, who?

Do you have any special problems with this child?

Is this child dependent or independent?

Please support the previous statement with examples:

Does this child play well with other children? Please elaborate:

Has this chuld had experience in playgroups?

Is this child toilet trained?

Does this child nap?

Please give specific examples of how you discipline your child:

Please give specific ground rules to which this child must adhere at home:

Have you read anything about or by Dr. Maria Montessori?

Suggested reading: "Maria Montessori, Her Life and Work" by E. Mortimer Standing; "The Secret of Childhood" by Maria Montessori; and "The Absorbent Mind" by Maria Montessori