Child Information: Male Female

___________________________________________________________First Middle Last Name

_______________ ______ ___________________________________Date of Birth Age Place of Birth

Previous School: _____________________________________________

Permission to contact previous school: ____________________________ Signature

Programs:

Half Day (8:30am-11:30am) Extended Day (8:30am-12:30pm) Kindergarten (8:30am-2:30pm) Kindergarten extra hrs: (hours:_______to______

Parent (Guardian) Information:

________________________________________________Mother s Name

________________________________________________Mother s home address

________________________________________________City State Zip

________________________________________________Home phone: area code - number

________________________________________________Mother s Cell phone: area code - number - carrier

________________________________________________Mother s Email Address

________________________________________________Mother s Occupation

________________________________________________Mother s Company Name

________________________________________________Company City State Zip

________________________________________________Company phone: area code - number

Work Hours: ________to________

Marital Status (circle one): married, single, divorced

Parent (Guardian) Information:

_______________________________________________Father s Name

_______________________________________________Father s home address

_______________________________________________City State Zip

_______________________________________________Home phone: area code - number

_______________________________________________Father s Cell phone: area code - number - carrier

_______________________________________________Father s Email Address

_______________________________________________Father s Occupation

_______________________________________________Father s Company Name

_______________________________________________Company City State Zip

_______________________________________________Company phone: area code - number

Work Hours: ________to________

Marital Status (circle one): married, single, divorced

Child s brothers and sisters:_________________________ _________________________Name Age Name Age_________________________ _________________________Name Age Name Age

Child s Grandparent s:_________________________ _________________________Name Phone # _________________________ _________________________Name Phone #

Child’s Grandparents:

Programs:

ToddlerPreschoolKindergartenElementary

Hours: to

DUPAGE MONTESSORI SCHOOLApplication: - 2019 2020

Days: M T W Th F

DUPAGE MONTESSORI SCHOOLApplication: -2019 2020

Withdrawal Policy:

If a parent decides to withdraw their child/children from theschool, a meeting needs to be arranged between

the parents,teacher, and directors of the school. A 30-day

written notice isrequired for withdrawal for which parents are

responsible fortuition during that time.

Application Procedure:

1. Submit application and registration fee of

$150 for one childor $180 for two children.2. Pay the deposit no later than one month after you submit theapplication.3. All prospective students and parents must visit theirclassroom prior to enrollment.

Important Health Information:

Allergies:__________________________________________

_________________________________________________

Health Restrictions:_________________________________

_________________________________________________

Physical Impairments:_______________________________

_________________________________________________

Parent has read and accepts school policies:

________________________________________________Parent (Guardian) Signature Date

Overview:

The Montessori method requires the school and theteacher to give extensive time to the preparation of thelearning environment before, during, and after theclassroom program. It is the many hours of preparationthat enables us to continue to present a quality educationalprogram.

I understand that students are admitted for the fullacademic year and that my agreement to pay for the fullacademic year is not subject to adjustments for illness,absence, school days closed for severe weather,withdrawal or dismissal, personal vacations or for anyschool holidays.

Permissions:

1) I grant permission to the school to take my child on fieldtrips, to include him or her in photographs and videos, andevaluation programs.2) I agree to have my family address and phone number inthe classroom directory.

Obligations:

In keeping with the spirit of Montessori Education whichemphasizes the importance of parent participation ineducation of the child, I agree:1) To attend parent-teacher conferences.2) To be supportive of the school-parent relationship.

Tuition Obligations:

Tuition is due on the first day of school and the first schoolday of every month through May. Checks returned forinsufficient funds will incur an additional $30.00 per checkfee.

If your child’s account is past due by more than 30 days,then you must contact the office to arrange a paymentplan.

Dis-enrollment Policy:

DuPage Montessori School reserves the right to dis-enrolla child after two meetings with a parent or guardian todiscuss school concerns.

DUPAGE MONTESSORI SCHOOLParent (Guardian) Agreement

- 2019 2020