Application

Lansdowne Montessori School

109 S. Lansdowne Ave.

Lansdowne, Pa 19050

(610) 284-1676

 

Sessions: Full day _____ (7:30 - 6:00) Half day _____(9:00 - 12:30)    

          3 full Days and 2 ½ day _____           2 full day and 3 ½ days _____

_____________________________________________________________

Childs Name  ____________________ Birthday __________ Age _____ Male_____ Female_____

Address ________________________ Town ____________ Zip  _______

Mother’s name or legal guardian ____________________

Soc. Sec. Number _____________ 

Home Phone _____________ Cell _____________

Address ________________________ Town ____________ Zip  _______

Occupation_______________ Business Address ____________________

Business Phone ____________

Father’s name or legal guardian ____________________

Soc. Sec. Number _____________ 

Home Phone _____________ Cell _____________

Address ________________________ Town ____________ Zip  _______

Occupation_______________ Business Address ____________________

Business Phone ____________

Previous school/s attended _____________________________________

Other Adults in the home ________________________________________

Other Children in the home ______________________________________

Behavior Habits (Nail Biting, finger sucking, tantrums, fears, etc.)

_____________________________________________________________

How do you handle them? _______________________________________

Name and address of person to be contacted in an emergency, if parents are not available _________________________________________________

Name and address of child’s physician or source of medical care

___________________________________ Telephone ________________

Special disabilities, if any _______________________________________

Any special medical or dietary information necessary for management in an emergency situation: allergies, medications, and special conditions

_____________________________________________________________

Child’s health insurance provider (Name of insurance company)

_____________________________________________________________

Signature of parent / guardian responsible for tuition

                             ____________________

                             ____________________

 

Registration fee $75.00 (non-refundable)

Date of Application __________

Date of Enrollment __________

                                                          _____________________

                                                          Donna Boswell