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 :*

[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

School

Name

First Last

Birthdate

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

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name