Thank you for your interest in Berkeley International Montessori School.
Please complete the application form below. Thank you!
Child's Information
Name
*
First Name
Middle Name
Last Name
Japanese Name/Kanji
*
Date of Birth
*
/
Month
/
Day
Year
Date
Age
*
Gender
*
Desired Start Date
*
/
Month
/
Day
Year
Date
Toilet Training Status
*
School/Daycare Currently Attending
*
Siblings:
*
Yes
No
Prior Group Play Exposure:
*
Yes
No
Plans for Kindergarten Year
*
Plans for Elementary Education
*
Target Language Goals (by end of 3 Year Cycle)
*
Intruductory Level : Basic cultural exposure and aural comprehension
Intermediate Level: Aural comprehension and intermediate speaking/writing ability
Fluency: Able to understand, speak, read,and Write at native level for age
Child's Residential Status
*
Lives with both parents
Shared custody of both parents
Lives with legal gardian(s)
Gardian #1
Gardian #2
Desired School Schedule
*
Full Day: 8 am-3 pm
Extended Day: 8 am - 6 pm
Interest in Applying to AIM
*
Yes
No
Family Information
Primary Parent/Gardian #1
Name
*
First Name
Last Name
Rerationship to Child
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Main Phone Number
*
Please enter a valid phone number.
Other Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Employer/Business Name
Occupation/Profession
Family Information
Secondary Parent/Gardian #2
Name
First Name
Last Name
Rerationship to Child
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Main Phone Number
Please enter a valid phone number.
Other Phone Number
Please enter a valid phone number.
Employer/Business Name
Email
example@example.com
Occupation/Profession
How Did You Hear About BIM?
*
Advertisement
Newspaper
Mgaazine
Web Search
Applied to AIM
Attended Open House*
Referred By**
Other
*Attended Open House : When?
*
**Referred by
*
Additional Information
Allergies/Health Concerns
Medications
Dietary Restrictions
Other
Parent/Guardian Signature
*
Clear
Date
*
/
Month
/
Day
Year
Date
Please include a family photo in the space below if mailing in this application via post, or kindly submit one as an attachment if youemail it in to us.
*
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Application Fee
Berkeley International Montessori School
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