Cedar Lane Enrollment Form

Please check program desired:*

Montessori School (9:00-12:00)
Montessori School Extended Day Program (7:30 - 4:30)
Montessori Full Day Program (7:30-6:00)

Please check the payment plan desired:*

Annual (1 payment) - due August 1
Semester (2 payments) - due Aug. 1 & Dec. 1
Installment Plan (10 installments) - due the 1st of each month - August 1 - May 1

Desired Start Date

We agree that our name, address and home phone will be listed on the Class Roster*

Yes
No

Child's Information

Child's Name*

First Last

Nickname

Sex*

Male
Female

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

Age*

Toilet trained?*

Yes
No

Child lives with

List all family members who reside with child.

Languages spoken at home

Names and ages of siblings

Previous school experience

Please list the school and how long the child attended

Is the child currently attending a school?*

Yes
No

Child's current school

Reason for leaving

Current school's phone number

Current School's Address

Street Address Address Line 2 City State ZIP Code

General statement of child's physical health*

Include allergies, medical conditions, etc.

Father's Information

Father's Name

First Last

Age

Employer

Occupation

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone

Cell Phone

Mother's Information

Mother's Name

First Last

Age

Employer

Occupation

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone

Cell Phone

Family Information

If parents are divorced or separated, to whom should all school correspondence be sent?

Is there a Custody Court Order agreement?

(A copy is required at enrollment)

Yes
No

From what source did you hear of the Cedar Lane Montessori School?

Contact Name*

Who is filling out this form?

First Last

Contact Email*

How may we get back in touch with you?

Contact Phone

Comments/Questions

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Comments

This field is for validation purposes and should be left unchanged.

Holly Brook Montessori

Child's Information

Father's Information

Mother's Information

Family Information

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