Enrollment Application
Montessori Center of Jackson, Inc
PLEASE NOTE:
A
non-refundable application fee of $35.00 is due with this form.
Application
Date:___________________ Enrollment Year:____________________
Child's Name_____________________________________________________________
Last
First
Middle
Male/
Birth Date Birth Place
Female______ ___/___/___
City, State______________________________
Address_________________________________________________________________
Street
_________________________________________________________________
City
State
Zip
Phone
Father:
________________________________________________________________________
Name
Address (if different from Child)
Phone
________________________________________________________________________
Cell Phone #
E-Mail Address
Social Security #
________________________________________________________________________
Occupation
Workplace
Work Phone
Mother:
________________________________________________________________________
Name
Address (if different from Child)
Phone
________________________________________________________________________
Cell Phone #
E-Mail Address
Social Security #
________________________________________________________________________
Occupation
Workplace
Work Phone
Other Schools
Attended:
___________________________________________________
Siblings:
_____________________________________ _________________________________
name
sex age name
sex age
_____________________________________ _________________________________
name
sex age name
sex age
Please indicate
program interest: ______ Early
Childhood Morning Program
______ Early Childhood Extended
Day
______ Kindergarten Program
______ Elementary Program
Are you interested in continuing through our elementary program ? yes_____ Not at this time_____
Signature of Parents:
___________________________________ __________________________________
