Pennsylvania Avenue Montessori School

Child Name

Grade

Gender

Child's Date of birth

Age of the Child at the time of enrollment

Approximate Start Date

How many days a week child attends

Please select the appropriate program: Full time 6.30 am - 6.00 pm

Please circle days

5days

4days

3days

2days

Mon

Tue

Wed

Thu

Fri

Potty training shedule from Teachers to help parents at home

YES

Allergies

Childrens Medications

Diet restrictions

Weekend care options

YES

Address

City:

State:

Zip

Mother Name

Mother Phone No.:

Mother E-mail

Father Name

Father Phone No.:

Father E-mail

Guardian Name

Guardian Phone No.:

Guardian E-mail

In case of emergency or illness, I authorize the following person to act on my behalf if I cannot be reached

Name

Phone No.:

E-mail

Address

Anything else?

The registration fee must accompany each application for enrollment before it may be processed. The registration fee is non refundable unless the application is not accepted. There are no refunds for tuition, holidays, illness or vacation. TWO WEEKS WRITTEN NOTICE IS REQUIRED PRIOR TO WITHDRAWAL. Monthly tuition not paid by the 5th of each month or weekly tuition not paid by by every Monday, will incur a late fee. The center reserves the right to request that a child be withdrawn if, in the opinion of the center, the child does not adjust or benefit from the program. I understand and agree to the above terms.

Registration Form