New Student Application
Sign in to Google to save your progress. Learn more
Email *
STUDENT INFORMATION
Student's First Name *
Student's Last Name *
Student's Preferred Name
Student's Date of Birth (DOB) *
MM
/
DD
/
YYYY
Student's Current Age
Program Applying For *
I am interested in Before and After School care (7:00 a.m. - 6:00 p.m.) *
Student's Gender *
Student is living with: *
Please check all that apply.
Required
Name of student's current or most recent school (if applicable) *
Please describe your child's special abilities, interests, temperament, challenges.
How do you think your child will benefit from an education at White Rock Montessori? *
Please describe any physical limitations which may affect your child's health, school work, or participation in physical activities.
During the past 12 months, has your child experienced any health, social, or emotional problems, or significant changes in the family? Please explain.
PARENT/GUARDIAN 1 CONTACT INFORMATION
Parent/Guardian Name *
First and Last Name
Relationship to Student *
Address *
Email Address *
Home Phone Number
Cell/Mobile Phone Number *
PARENT/GUARDIAN 2 CONTACT INFORMATION
Parent/Guardian Name
First and Last Name
Relationship to Student
Address
Email Address
Home Phone Number
Cell/Mobile Phone Number
Sibling's Name(s), Age(s), and School(s)
Please list any relatives who are attending or who have attended White Rock Montessori.
Thank you for submitting an application to White Rock Montessori School. Upon receipt of this application your child will be placed in our waiting pool and when an opening becomes available we will contact you to schedule a student visit. We look forward to the possibility of your family joining the White Rock Montessori Community.
How did you hear about White Rock Montessori?
The information in this application is confidential. The School does not discriminate on the basis of race, color, gender, nationality, or ethnic origin in administration of its educational policies, admission policies, scholarship programs, or other school administered programs
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of White Rock Montessori School. Report Abuse