Little Village Montessori Application Form

Submission

MonthDay Year
Little Village Montessori
Child Development Center

7126 SE Milwaukie Ave. Portland, OR 97202

Phone: (503) 567-9436 Email: littlevillagemontessori1@gmail.com

www.littlevillagemontessori.com
Little Village Montessori Wait List Application
Thank you for your interest in Little Village Montessori! Please fill out the form below to the best of your ability. Your answers will help us determine how best to support your child's and family's needs.
Child's Name*

First Name Last Name
Nickname
Child's Pronouns
Birth Date*

Month Day Year
Age Group (on or before August 31st, 2023) [we are fully enrolled for the 2022-2023 school year]*
We offer a year round, full time program.

Our Standard Hours are Monday - Friday, from 8:30am - 3:00pm.

Standard Tuition for Infant Care is $1875 per month for 12 months.

Standard Tuition for Toddler Care is $1445 per month for 12 months.

Standard Tuition for Primary Care is $1175 per month for 12 months.

We offer Extended Morning Care from 7:30am - 8:30am for an additional $150 per month.

We offer Extended After Care from 3:00pm - 6:00pm for an additional $300 per month.
Schedule Needs*

Standard Infant CareStandard Toddler CareStandard Primary CareExtended Morning CareExtended After CareUnsure of Extended Care needs at this time
Please indicate your intended length of stay at LVM:

Pre-KThrough KindergartenNot sure at this time
Preferred Start Date

Earliest availabilitySummer 2023Fall 2023Other
Parent's Name:*
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Number*
Cell Number*
Work Number
Email*
example@example.com
Employer and Occupation
Parent's Name:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Number
Cell Number
Work Number
Email
example@example.com
Employer and Occupation
Siblings' Names and Ages
Do you have another child you wish to enroll?
If yes, please enter their name and age below. You will need to submit a separate form for each child.
Please list the names and relationships of all other persons living in the child's home:
Are the child's parents

living togetherseparateddivorcedeither parent deceased
Is your child regularly cared for by someone other than the parents? If so, please explain:
Is your child on any medications or have any allergies?
Is your child under the care of a physician, psychiatrist, therapist, or psychologist?
What do we need to know about your child that would help us optimize their learning experience? What do you find most endearing about your child? What do you find most challenging?
Do you have any special concerns about your child's health or development?
Please list child's previous school or daycare experience:
Have you had previous association with or knowledge of the Montessori teaching method? If yes, please describe:
What are your expectations regarding your child's learning experience at LVM?
How does your child respond to correction or discipline?
How does your child interact with peers and adults?
Has your child had any difficulties in school? If so, what supports have you and/or the school provided?
Is your child potty-trained (required for Primary program)?*

YesNoPartially
Does your child nap?*

YesNoOccasionally
How did you learn about Little Village Montessori?
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