Child's Full Namerequired

Today's Daterequired (mm/dd/yyyy)

Name Child goes by

Date of Birthrequired (mm/dd/yyyy)

Genderrequired

Home Phone Numberrequired

Address 1required

Cityrequired

Staterequired

Ziprequired

Email Fieldrequired

Requested Date of Enrollmentrequired (mm/dd/yyyy)

Do you agree to haveyour address, phone # and email shared with other parents of the school?*

Yes No

How did you hear about Naudain?required

Father's namerequired

Occupation & Employerrequired

Business Addressrequired

Work Phonerequired

Cell Phonerequired

Mother's Namerequired

Occupation & Employerrequired

Business Addressrequired

Work Phonerequired

Cell Phonerequired

Sibling's Namerequired

genderrequired

Agerequired

Schoolrequired

What language(s) does your child speak?required

What language(s) is spoken at home?required

Have any of your children attended a Montessori School?*

Yes No

When?required (mm/dd/yyyy)

Where?required

List previous school experience(s) of your child.required

What are your immediate goals for your child?required

Why do you feel that Naudain Montessori Academy is an appropriate choice for your child?required

What would you like us to know about your child (temperment, learning style, separation, etc...)? ** Please forward any child study team reports, if applicablerequired

Is your child toilet trained? (diapers and/or pull-ups may not be worn except in the Toddler Program)*

Yes No

Does your child nap?*

Yes No

Do you know if your child is right-handed or left-handed?required

Does your child dress himself/herself?*

Yes No

What form of discipline is used at home?required

Does your child have any medical conditions or allergies? If yes, list and explain.*

Yes No

Please Indicate the Program you are interested in:*

Toddler (18 months - 3 Years) Primary (3 -6 years) Kindergarten/Extended Day *This is a 5 full day curriculum (must be 5 yrs. by 10/1)

Please indicate the # of days*

3 Days 5 Days

If 3 Days, please indicate which 3 consecutive days.

Please indicate the hours you are interested in:*

Half Day AM (8:30am-noon) Full Day (8:30am-3pm) All Day (7:30am-6pm)

Additional Care Hours

3 Days Early Care Hours (Before 8:40) 5 Days Early Care Hours (Before 8:40) 3 Days After Care Hours (After 3pm) 5 Days After Care Hours (After 3pm)

All new students must complete a Phase-In period (abbreviated schedule).

A $125 non-refundable application fee must accompany this application.

Please make checks payable to Naudain Montessori Academy. Thank you!