Idyllwild Montessori School

53785 Country Club Dr, Idyllwild, CA 92549 MAIL: PO BOX 1328, Idyllwild, CA 92549 (646)706-1513

PLEASE PRINT

APPLICATION FOR ADMISSION

Toddlers (age 2-3) __ PreSchool (age 3-5) __ Kindergarten (age 5-6) __ Elementary (age 6-9) __

Name of Student_____________________________________________________________________

Address ___________________________________________________________________________

(Street)

__________________________________________________________________________________

(City) (State) (Zip)

Home Phone __________________Sex______Age_____Date of Birth_________________________

Father’s Name______________________________Business Phone___________________________

Business Name______________________________________________________________________

Business Address____________________________________________________________________

Occupation_________________________________________ Cell Phone ______________________

Email Address: _____________________________________

Mother’s Name_____________________________Business Phone____________________________

Business Name______________________________________________________________________

Business Address____________________________________________________________________

Occupation_________________________________________ Cell Phone _____________________

Email Address: _____________________________________

Children Living With_________________________________

Other Children in the Family (Names & Ages) ____________________________________________

Is there any medical, environmental, or behavioral history that would be useful in helping to understand

your child? _______________________________________________________________________

Child’s Pediatrician_____________________________________________Phone_______________

Address_________________________________________________________________________

Emergency Contact_________________________Relationship_____________________Phone______________

Please indicate your choice for number of days and hours needed:

Number of Days 5 Full Days ______ 3 Full Days (MTW)______ 2 Full Days (THF)_____

5 Half Days AM ________ 3 Half Days AM __________ 2 Half Day AM _____

5 Half Days PM _________ 3 Half Days PM __________ 2 Half Day PM _____

Will you need extended hours? Yes ___ No ___ If yes, AM (7-9) ____ PM (3-7) ____

Signature____________________________________________Date___________________________