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Starry Garden Montessori School
2019-2020 School Year
Students Legal Name *
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Child's Age *
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Child's Birth Date *
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Address *
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Mothers Name *
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Mothers Phone Number *
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Mothers Email Address *
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Fathers Name *
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Fathers Phone Number *
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Fathers Email Address *
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Other Languages in the home
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Names of person, relationship and phone number of adults able to pick up your child from school. example: John Smith, Grandpa, 801-555-5555 *
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Password- 10 characters or less (for emergencies, your child does not need to know the answer, but the person you send to get your child in an emergency situation needs to know it.) *
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5 days a week (choose none if not applicable) *
4 days a week (choose none if not applicable) *
3 days a week (choose none if not applicable) *
2 days a week (choose none if not applicable) *
What days will you child attend *
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Extended Day *
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Please give more detail of Extended Day, as needed.
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Does your child have food Allergies *
Please explain allergies if "yes"
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Does your child have any medical issues *
Please explain allergies if "yes"
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Does your child need diapering or potty training assistance?
If "yes" please explain the extent of the care needed. There is an additional 10% charge for this service, and it is required for any child who is not fully independent in the restroom.
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I give permission for picture and video of my child to be taken at Starry Garden School and posted on the private Facebook page for Parents and other family members approved by administration. *
A teacher my choose to apply the following, parent supplied, products as need. (Check all that apply) *
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I will pay my registration fee the following way. *
I prefer to pay my Quickbooks invoice the following way. *
Please bring in or email a copy of your child's immunization record or immunization exemptions form before or on the first days of school. Email- starrygardenmontessori@gmail.com
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Tell us about your child.
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What does he/she like to talk about?
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Please list names and ages of any siblings.
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Comments for staff
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