New Student Admissions Application

White Rock Montessori School > New Student Admissions Application

Student's Information
Student’s Name*
First Name : Middle Name : Last Name : Preferred Name
Present Grade :
Grade applying for:*
Birth Date :*
Date Format: MM slash DD slash YYYY

[mm-dd-yyyy]
Age :
Gender :*
- Male
- Female
Current or most recent school :
Grades attended :
School address
Street Address Address Line 2 City State ZIP Code
School's Phone Number
School's Principal, Director, or Head :
During the past 12 months, has your child experienced any health problems, social or emotional problems, or significant changes in the family? Please explain.
Please describe your child’s special abilities, interests, temperament, challenges :
Please describe any physical limitations which may affect your child’s health, school work, or participation in physical activities :
How do you think your child will benefit from White Rock Montessori School?
Have any behavioral, educational, or psychological evaluations been performed on your child?
- Yes
- No
If yes, when, by whom, and for what reason? Please send a copy of all relevant reports to office@whiterockmontessori.org.
Has your child ever been dismissed or suspended from any school?
- Yes
- No
If yes, please explain :
Please list any medications your child is currently taking:
Has your child previously applied to White Rock Montessori?*
- Yes
- No
If yes, when and for what grade?
Student is living with:
- Father
- Mother
- Stepfather
- Stepmother
- Legal Guardian
- Grandmother
- Grandfather
- Other
Please check all that apply.
Parent/Guardian 1
Relationship to Student*
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Home Phone
Cell Phone*
Place of Employment
Title
Parent/Guardian 2 (if applicable)
Relationship to Student
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Email
Home Phone
Cell Phone
Place of Employment
Title
Siblings
Name
First Last
Birthdate
Date Format: MM slash DD slash YYYY
School
Name
First Last
Birthdate
Date Format: MM slash DD slash YYYY
School
Please list any relatives who are attending or have attended White Rock Montessori
Name Dates of Attendance (Years) Relationship to Applicant

Please click the + to add more.
Grandparents 1
Name
First Last
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Grandparents 2
Name
First Last
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
If student’s parents are divorced, which parent has legal responsibility for
School-related decisions :
- Father
- Mother
School bills :
- Father
- Mother
Custody of student :
- Father
- Mother
Receiving school communications :
- Father
- Mother
Enrollment Procedure
I agree to the Enrollment Procedure mentioned below*
- Yes
Subsequent to our receipt of this application, duly completed, and the application fee, your child will be placed in our waiting pool. When an opening becomes available, you will be notified, at which time a classroom observation for you and an interview for your child will be scheduled. If you, the interviewing teacher and the administrator feel that our environment will satisfy the individual needs of your child, the non-refundable enrollment fee shall be paid. When the applicable tuition has been paid, the child will be admitted on a six-week trial basis. Elementary and middle school students transferring from other schools must make available their school records.
Terms
I agree to the Terms mentioned below*
- Yes
Students are accepted only for the entire academic year, or for the remainder of the school year if enrolled after the opening date. The fact that the school allows tuition to be paid in two or more installments in no way creates a fractional contract or in any way relieves the parent/guardian/responsible party for the entire year’s tuition. No reduction or credit will be granted if the student is withdrawn unless such withdrawal is made at the specific request of the school.
The information in this application is confidential. The School does not discriminate on the basis of race, color, gender, nationality, or ethnic origin in administration of its educational policies, admission policies, scholarship programs, or other school administered programs
How did you become interested in White Rock Montessori?
- Website
- Current White Rock Montessori Family
- Advertisement
- Alum
- Other
New Student Application Fee
Total
$0.00
Credit Card*

American Express
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MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

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Name	Dates of Attendance (Years)	Relationship to Applicant

Student's Information

Parent/Guardian 1

Parent/Guardian 2 (if applicable)

Siblings

Grandparents 1

Grandparents 2

If student’s parents are divorced, which parent has legal responsibility for

Enrollment Procedure

Terms