Information Form

Information Form

Highland Montessori
Child's Information
First Name*
Gender*

MaleFemale
Birth Date*

MonthDayYear
Address*
City*
State*
Please describe your child's experience in other childcare programs:
List any allergies
Example: Peanuts, bees, etc
List any dietary needs or restrictions (gluten, dairy, meat, etc)
Example: Vegetarian, dairy-free
Family Information
Parent/Caregiver*
Relation*
Phone*

Area CodePhone Number
Email*
example@example.com
Parent/Caregiver
Relation
Phone

Area CodePhone Number
Email
Schedule
When are you looking to enroll your child?*

2024-2025 School Year2025-2026 School Year2026-2027Other
Would you be looking for a part time or full time position?*

Full Time 5 Days/WeekPart Time 3 Days/WeekPart Time 2 Days/WeekOther
How did you hear about us?
Friend (who), Yelp, Google Search, Promotional Event, Walking By
Additional Questions or Comments:
Should be Empty:

Child's Information