Registration Package – head start montessori

Registration Package

Head Start Montessori and Private School Registration Form

Date of admission

Student Information

First name

Last name

Date of birth

Sex

Address

City

Postal code

Telephone (home)

Previous school

Languages spoken at home

Please indicate program and other preferences

Will your child require an afternoon nap?

My child requires an afternoon nap My child does not require an afternoon nap

Will your child require extended care?

My child requires extended care My child does not require extended care

Will your child require before/after school care?

My child requires before/after school care My child does not require before/after school care

Parents Information

Mother / Guardian

First name

Last name

Address (If different than child):

Telephone (home)

Telephone (cell)

Email address

Father / Guardian

First name

Last name

Address (If different than child):

Telephone (home)

Telephone (cell)

Email address

Siblings

Full Name

Sex

Date of birth

Full Name

Sex

Date of birth