STUDENT ENROLLMENT APPLICATION
GREENBRIER MONTESSORI SCHOOL
1100 Greenbrier Parkway, Chesapeake, Virginia 23320 Phone 757-549-8584
Academic School Year 2008-2009
Applying for: Toddler _____ Children’s House _____Elementary _____
Part time___ Regular___ Full day___
1. STUDENT INFORMATION
__________________________________ _________________________ ________
Full Name of Student Nickname Gender
___________________________________ _________________ __________ ___________
Home Address City State Zip
________________________ ______/_______/______ _____________
Home Phone Number Date of Birth Age
2. MEDICAL HISTORY
________________________________________________________________________
Any allergies (please list) Long-term medications (please list)
_____________________________________________________________________________
Any pre-existing medical conditions or illnesses such as diabetes, asthma, etc.
_____________________________________________________________________________
Does your child have any special physical, cognitive or emotional needs? Please specify.
_____________________________________________________________________________
Has this child been seen by a medical specialist? Please specify.
3. FAMILY
_______________________________ _________________________________________
Father’s Name Mother’s Name
_______________________________ _________________________________________
Father’s SSN Date of Birth Mother’s SSN Date of Birth
_______________________________ _________________________________________
Father’s Current Employer Mother’s Current Employer
_______________________________ __________________________________________
Employer’s Address Employer’s Address
_______________________________ __________________________________________
Father’s Occupation Mother’s Occupation
_______________________________ ________________________________
Work number Cell number Work number Cell number
Name of a relative not residing with you:_____________________________________
Address/City/State/Zip:_________________________________________________________
Phone Number:____________________Relationship__________________
Student lives with: ____ Both Parents ____ Mother ____ Father Other __________
Parent(s) are: ____ Married ____ Separated ____ Divorced ____ Remarried ____Single
Custody documents required? ____ *Parents are responsible for informing the school of any changes
Who has authority to make educational decisions for the child?__________________________
Name(s) of adult(s) responsible for tuition payments________________________________
Sibling information (names and ages)_____________________________________________
4. EDUCATIONAL BACKGROUND
___________________________________________________________________
Student’s current school Student’s current grade level
_____________________________________________________________________________
Reason for leaving current school
_____________________________________________________________________________
Any previous Montessori experience? If yes, list school attended, location, and phone number
_____________________________________________________________________________
Other schools attended, please list
5. Why do you want your child to attend Greenbrier Montessori School? ____________
____________________________________________________________________________
____________________________________________________________________________
6. What is your best estimate for how long you plan to remain at Greenbrier Montessori School?
_____________________________________________________________________
7. I/We understand that my attendance at parent meetings, class meetings and parent conferences is an important factor in my child’s development within GMS program. I will make every effort to attend.
__________________________________________ (please sign)
8. I/We understand that toddlers not fully potty trained will be charged an additional $25.00 per month (for diaper changing), which will be added to the monthly tuition.
*See Parent Handbook* for details. ____________________________________ (please sign)
9. I/we understand that if my child is enrolled at GMS, I/we will be obligated to fulfill not less than 8 hours of service per child per academic year. I/we have the option to pay a fee of $100.00/per child in lieu of providing service hours. ______________________ (please sign)
10. Desired start date: ______________________
I/We hereby apply for admission of the above named child to Greenbrier Montessori School, and I/we enclose a non-refundable application fee of $50.00. Fee does not suggest acceptance. It only begins the enrollment process. I/we have read the brochure and understand the principles and purposes of Greenbrier Montessori School. I/we understand that once my child enrolls in GMS, I/we are financially obligated for the full year. I/we understand that GMS reserves the right of suspension or dismissal at any time during the year for non-compliance with our school policies. Students are accepted on a tentative basis, pending a determination of suitability of the program for the child and the ability to adjust to the group environment. All monies prepaid are non-refundable, including, but not limited to, deposits, registration, advance tuition, etc.
Greenbrier Montessori School is a private school dedicated to academic excellence in early childhood education. It is NOT a daycare center. Extended care is provided as an additional service of the school, not as its primary function.
__________________________________________________________________
Signature of Parent(s) or Guardian(s)Date
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OFFICE USE ONLY
Date of application ______ Date Enrolled _______ Date Started ______
Last Date Attended________
Application Fee __________________Trial day(s) scheduled for _______________________
Staff member’s signature ____________________________________Date ______________