93 Center Street – Nobleboro, ME 04555 – 207.563.2168

APPLICATION FOR ELEMENTARY – MIDDLE SCHOOL ADMISSION($35 FEE)
□Elementary Program
□ Lower Elementary (grades 1-3)
□ Upper Elementary (grades 3-6) / □Adolescent Program – Middle School
Grades 7 and 8

Child Information

Full Name: / Date of Birth:
Nickname: / Gender: Male Female
Home Address: / Home Phone:
Sibling: Age: / Sibling: Age:
Sibling: Age: / Sibling: Age:

Family Information

Mother’s Name: / Father’s Name:
Mailing Address: / Mailing Address:
Home Phone: / Home Phone:
Cell Phone: / Cell Phone:
Occupation: / Occupation:
Place of Business: / Place of Business:
Work Address: / Work Address:
Work Phone: / Work Phone:
Email: / Email:

Medical Information

Pediatrician Name: / Allergies:
Pediatrician Address: / Restrictions:
Physical Impairments:
Pediatrician Phone: / Hearing: Vision:

In Accordance with Federal Law and USDA policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability (not all prohibited bases apply to all programs). To file a complaint of discrimination, write to the: USDA, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Ave SW, Washington, DC 20250-9410, or call1-800-795-3272 (voice) or 202-720-6382 (TDD). USDA is an equal opportunity provider and employer.

Educational Information

Previous School Name: / School Name:
School Address: / School Address:
School Phone: / School Phone:
Duration: / Duration:
Grade Level: / Grade Level:
Reason for Leaving: / Reason for Leaving:
What are the goals (educational and other) that you have for your child while at DMS?
How do you see this child in his/her social/emotional development?
Does your child have any special talents or needs that we should be aware of?
Is there any significant medical history and/or diagnostic evaluations that have been completed for this child? If so, please send along information and/or the IEP /evaluations that have been made:
Are you aware of any areas in which we might be able to give special help/encouragement to this child?:
How did you hear of DMS? Through what age do you plan to have your child attend DMS?

Application Procedure

  1. Parent tour and interview with the school’s administration.
  2. Application and non-refundable application fee due prior to child visit.
  3. Student Record Release Form Signed
  4. Child visit to the classroom.
  5. Notification of admissions decision.
  6. Enrollment deposit and enrollment agreement are due upon acceptance.

Signature of parent or guardianDate

Damariscotta Montessori School considers the records of all individual students to be confidential information available to a child’s parents or guardians upon request. Records will only be released to other schools or agencies upon signed request from a parent or guardian and only after all accounts due are paid in full.

93 Center Street – Nobleboro, ME 04555 – 207.563.2168

e-mail ~

Student Record Release Form

Date: ______

Name of Student: ______

Present/Previous School: ______

School Address: ______

______

□This student is applying to DMS – need to peruse a copy of relevant records and/or speak to teacher(s).

□This student is now enrolled at DMS – please transfer below records to the school

I give my permission for the perusal and/or transfer of copies of my child's records to the Damariscotta Montessori School. The records should include copies of the following:

□Transcripts of grades or evaluations.

□Results of all standardized tests.

□Individual Education Plan, if applicable.

□Other information maintained in student's permanent record such as attendance .

I also give my permission to have the faculty of DMS speak with the student’s current teacher(s) to discuss the student’s records, progress, curriculum, and activity/participation in the classroom.

GRADE TEACHERS NAME

______
Parent SignatureDate

Send requested information to:

Admissions

Damariscotta Montessori School

93 Center Street

Nobleboro, ME 04555
207.563.2168 FAX 207.563.3871 (please call first)