Enrollment/Registration Form
Santa Monica Montessori School
Program/Grade Level of Applicant
*
Toddler
Preschool
Kindergarten
Elementary (Ages 6 through 12)
Date of Application
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Data of Enrollment
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
School Currently Attending:
*
Current Grade:
*
Student Information:
Student's Name
*
First Name
Last Name
Student's Nick Name (if any):
Date of Birth:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender:
*
Number of Siblings and Names:
Siblings Currently Enrolled at SMMS:
With Whom Does the Child Currently Reside?
*
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Parent/Guardian Information:
Information of First Parent/Guardian
Name of First Parent/Guardian:
*
First Name
Last Name
Employer of First Parent/Guardian:
*
Occupation of First Parent/Guardian:
*
Email Address of First Parent/Guardian:
*
example@example.com
Phone Number of First Parent/Guardian:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Marital Status of First Parent/Guardian:
*
Married
Divorced
Separated
Widowed
Single
Address of First Parent/Guardian:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Information:
Information of Second Parent/Guardian
Name of Second Parent/Guardian:
First Name
Last Name
Employer of Second Parent/Guardian:
Occupation of Second Parent/Guardian:
Email of Second Parent/Guardian:
example@example.com
Phone Number of Second Parent/Guardian:
Please enter a valid phone number.
Format: (000) 000-0000.
Marital Status of Second Parent/Guardian:
Married
Divorced
Separated
Widowed
Single
Address of Second Parent/Guardian (if different from the first parent/guardian):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Admissions Enrollment Agreement
Enrollment
Admissions Enrollment Agreement
Tuition
Admissions Enrollment Agreement
School Hours
Admissions Enrollment Agreement
Withdrawal
Admissions Enrollment Agreement
Holidays and School Closings
Admissions Enrollment Agreement
Credits
Admissions Enrollment Agreement
Special Needs
Admissions Enrollment Agreement
Termination
Admissions Enrollment Agreement
Arbitration
Admissions Enrollment Agreement
Renewal
In consideration of the acceptance of my child as a student at Santa Monica Montessori School:
I/We, the undersigned, agree to hold harmless and indemnify the Board of Directors, Personnel, and Staff of Santa Monica Montessori School against any and all claims made by or on behalf of:
Child's Full Name:
*
First Name
Last Name
Signature Required To Finalize:
*
Please Select:
*
Please Select
Mother
Father
Guardian
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature Required To Finalize:
Please Select:
Please Select
Mother
Father
Guardian
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Emergency Instructions:
Student's Name:
*
First Name
Last Name
Student's Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian's Name:
*
First Name
Last Name
Emergency Email:
*
example@example.com
Emergency Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Parent/Guardian's Name:
First Name
Last Name
Additional Parent/Guardian's Email:
example@example.com
Additional Emergency Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
In case of an emergency, who else should we contact?
Name #1:
First Name
Last Name
Relationship to Student:
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Name #2:
First Name
Last Name
Relationship to Student:
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Name #3:
First Name
Last Name
Relationship to Student:
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Please list all known allergies and medical conditions (asthma, medications, etc.)
*
Parent/Guardian's Initials:
*
Date Updated:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Allergy Report:
THIS REPORT IS TO BE POSTED IN THE CLASSROOM AND THE KITCHEN.
Student's Name:
*
First Name
Last Name
All Known Allergies:
*
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