Admission Application for Toddler, Primary, and Elementary

ADMISSION APPLICATION FOR TODDLER, PRIMARY, AND ELEMENTARY
Full Name of Child*

First NameMiddle NameLast Name
Child's Nickname
Date of Birth*

MonthDayYear
Date
Age*
Gender*
Place of Birth*
If your child is starting mid school year, please note your preferred start date*

MonthDayYear
Date
Applying for:*

Toddler Community Mornings (M-Th) (16 months-3 years)Toddler Community Full Day (M-F) (16 months-3 years)Primary Mornings (3 years-6 years)Primary Full Day (3 years-6 years)Elementary (1st-5th grade)
Name of parent(s) or guardian(s) with whom child primarily resides:
Parent/Guardian 1*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.
Home phone*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

CityState

Zip Code
Parent/Guardian 2*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.
Home phone*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

CityState

Zip Code
Person(s) financially responsible for tuition *

First NameLast Name
First NameLast Name
Why do you wish to send your child to Mountain Laurel Montessori School?
How did you hear about Mountain Laurel Montessori School?
PERSONAL HISTORY FORM
Child's age when first walked*
Child's age when he/she learned to use the toilet during the day*
and at night*
Does your child nap?*
Length of nap*
Child's bedtime*
Describe bedtime ritual*
Time child usually awakens*
Describe morning routine*
Describe any special circumstances surrounding your child's birth*
Name all persons living in child's home and relation to child*
Other places child has lived and length of time*
Extended family in the area*
How often does child see grandparents?*
Name, address and phone of other schools or daycare your child has attended*
How do you anticipate your child's reaction to a new school situation?*
How often does your child play with other children and what are their ages?*
Describe activities your child enjoys*
Types and names of household pets*
Does your child help with daily care of pets?*
How many hours of television or videos does your child watch per day?*
per week*
How many hours does your child play on the computer/tablet or electronic games per day?*
Per week*
Does your child choose his/her own clothes (never, sometimes, usually, always)?*
Does your child dress independently?*
Does your child use the bathroom independently?*
Method of discipline used by parent/guardian 1*
Method of discipline used by parent/guardian 2*
Has your child lived through any personal trauma?*

YesNo
If yes, please explain. *
I hereby acknowledge and represent that the information provided in this application is true, correct, and complete to the best of my knowledge, and I further acknowledge that a material omission or false information may constitute grounds for dismissal from Mountain Laurel Montessori School.
Parent or Guardian*

First NameLast Name
Parent/Guardian Signature *

Clear
Date*

MonthDayYear
Date
Your application will be processed when we recieve the $150 non-refunable application fee. Please bring your check, money order, or cash to the school or mail it to the address below. Checks should be made out to MLMS. Please include your child's name on the check.

Mailing Address:

Mountain Laurel Montessori School

PO Box 102

Front Royal, VA 22630
Should be Empty:

ADMISSION APPLICATION FOR TODDLER, PRIMARY, AND ELEMENTARY

PERSONAL HISTORY FORM