Middle School Application

MIDDLE SCHOOL ADMISSION APPLICATION
Full Name of Child *

First NameMiddle NameLast Name
Gender*
Applying for:*

6th Grade7th Grade8th Grade
Date of Birth*

MonthDayYear
Date
Age*
Place of Birth*
Parent/Guardian 1*
Cell Phone*
Email*
example@example.com
Parent/Guardian 2*
Cell Phone*
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Alternate Home Telephone Number
Person(s) Financially Responsible for Tuition*

First NameLast Name
First NameLast Name
Name, address and phone of other schools or daycare your child has attended*
Why do you wish to send your child to Mountain Laurel Montessori School?*
How did you hear about Mountain Laurel Montessori School?*
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 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:

MIDDLE SCHOOL ADMISSION APPLICATION