Class and Hours Applying For

The Montessori Centre Rodney Heights, Gros Islet An Extension of Wee Wisdom Montessori P.O. Box 220, Castries St. Lucia, West Indies (758)452-8114; Fax 452-9409; or

APPLICATION FOR ADMISSION

Child’s Name / First: / Middle: / Surname:
Sex: / Male ( ) / Female ( )
Date of Birth: / Day / Month / Year / Country of Birth:
Nationality:
Starting date requested / Day / Month / Year

CLASS AND HOURS APPLYING FOR

Infants
3 months – 18 months / Toddlers
18 months – 3 years / Pre-Primary
3 years – 5 years
8 a.m. – 11 p.m. ____
8 a.m. – 1 p.m. _____
8 a.m. – 3 p.m. _____
8 a.m. – 5 :00 p.m. ____ / 8 a.m. – 11 p.m. _____
8 a.m. – 1 p.m. _____
8 a.m. – 3 p.m. ______
8 a.m. – 5 :00 p.m.____ / 8 a.m. – 1 p.m. ____
8 a.m. – 3 p.m. ____

GRADES (Please Tick)

Hours here are
8 a.m. – 3p.m. / Reception G1 G2 G3 G4 G5 G6
[ ] [ ] [ ] [ ] [ ] [ ] [ ]

SIBLINGS

Siblings / Sex / Age / Enrolled at Montessori Centre
Name: / Yes [ ] No [ ]
Name: / Yes [ ] No [ ]
Name: / Yes [ ] No [ ]

LAST TWO SCHOOLS ATTENED ( begin with last school)

Name and address of school / Years attended / Last Class
20 ____ - 20_____
20____ - 20______

LANGUAGE PROFICIENCY ( please tick )

Language proficiency ( please tick )
English Language ______None _____ Fair _____ Good ____ Fluent_____
Other languages, please list: ______
ADDRESS WHERE CHILD RESIDES
Postal: / Residential:
Cell: / Tel.: / Fax:
Email:

Parents

Child lives with:
Mother [ ] Father [ ] Both parents [ ] Other [ ]
Father’s name: / Nationality:
Father’s Occupation:
Father’s WorkPlace and Address:
Father’s Worktelephone number:
Father’s Cell number / Father’s Work Email:
Father’s Work Fax Number:
Mother’s Name: / Nationality:
Mother’s Occupation:
Mother’s Work Place andaddress:
Mother’s Work Tel.:
Mother’s Cell: / Mother’s Work Email:
Mother’s Work Fax:
Name of Guardian or other/ Relationship / Nationality:
Telephone:
Cell: / Email:
How did you hear about The Montessori Centre?
What educational goals do you have for your child(ren)?
Allergies or any medical conditions of your child that we should know about:

If child does not live with parents please indicate under whose care and relationship to the child.

Name: ______Relationship:______

Address:______Tel.:______Cell:______

EMERGENCY: Name, address, and telephone number of person to be contacted in case of an emergency.

Name: ______
Address:______
Tel.:______Cell:______
Email:

Please tick if address is of:

Both parents ( ) Mother ( ) Father ( ) Guardian ( ) Other ( )

Please specify name of guardian or other.

I give permission for my child (ren) to be photographed and appear in media presentation.

I do not give permission for my child (ren) to be photograph or appear in media presentation.

SIGNATURE OF BOTH PARENTSDATE

______