Montessori Habitat School

Application for Admission

Student Information
Child's Name*
First Last
Gender*
- Male
- Female
- Self Identify
Age*
Date of Birth*
Date Format: MM slash DD slash YYYY
Home Phone Number(s)*
Child’s Home Address*
Street Address City State / Province / Region ZIP / Postal Code
Parent (or Guardian’s) #1 Information
Parent/Guardian 1 Name*
First Last
Home Address*
Same as child's address

Street Address City State / Province / Region ZIP / Postal Code
Occupation*
Place of Employment*
Address*
Work Hours*
Work Phone Number*
Cell Phone Number*
Email Address*
Add Parent (or Guardian’s) #2 Information?*
- Yes
- No
Parent (or Guardian’s) #2 Information
Parent/Guardian 2 Name*
First Last
Home Address*
Same as child's address

Street Address City State / Province / Region ZIP / Postal Code
Occupation*
Place of Employment*
Address*
Work Hours*
Work Phone Number
Cell Phone Number*
Email Address*
Siblings Information
Siblings:
Name Age School
Check the desired class that applies to this application:*
- Primary (Preschool) 9:00 - 2:00, Monday – Friday, Ages 3 and 4 years
- Primary Extended (Kindergarten) 9:00 - 3:30, Monday – Friday, Age 5 by September 1st
- Elementary 9:00 - 3:30, Monday – Friday
- Middle School 9:00 – 3:30, Monday – Friday
Please check all the offerings below that are needed for your family:*
- Immediate Opening
- Fall of ________ (year)
- Before School Care (8:00 - 9:00 am, all ages)
- After School Care (offered in 30 minutes increments from 3:30 until 5:30 pm, K – 8th)
Fall of (year)*
How did you learn about Montessori Habitat?
Why do you feel that Montessori Habitat is an appropriate choice for your child?
Through which level/grade will your child be attending Montessori Habitat?
Tell us about your child (temperament, personality traits, behavioral challenges, learning style, health conditions/allergies, emotional challenges, strengths and weaknesses, study habits, special interests, etc.):
What are your immediate goals for your child?
Please share any other information about your child or family situation:
Please list all the previous schools your child has attended:
Name Address Date of Attendance
Has your student ever been dismissed from school for any reason?*
- Yes
- No
What Grade
If yes, please explain the circumstances and provide both the name of the school and of the principal
Has your child skipped a grade?
- Yes
- No
What Grade
Has your child repeated a grade?
- Yes
- No
What Grade
Has your child been in advanced classes?
- Yes
- No
What Grade
What Curriculum
Does your child have any academic challenges?
- Yes
- No
Please explain
Has additional tutoring or professional testing been recommended at any point in school?
- Yes
- No
For what subject area(s)?
Does your child have any clinically diagnosed learning differences?
- Yes
- No
If so, what is the diagnosis and when was it diagnosed?
The families of kindergarten, elementary, and middle school students will be requested to furnish teacher references and additional supporting documents to aid in the selection process.
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY

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Name	Age	School

Name	Address	Date of Attendance

Montessori Habitat School

Student Information

Parent (or Guardian’s) #1 Information

Parent (or Guardian’s) #2 Information

Siblings Information

The families of kindergarten, elementary, and middle school students will be requested to furnish teacher references and additional supporting documents to aid in the selection process.

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