Student Application | Little Rock Montessori School

Application

School Year *

Campus Preference *

Program *

Pickup Time *

Desired Start Date

Child

Last Name *

First Name *

M.I.

Sex *

Date of Birth *

Place of Birth

Previous School Experience (optional)

Montessori School Name

Duration

Preschool / Daycare

Duration

Mother's Day Out

Duration

Parent / Guardian 1

Name *

Email *

Address *

Cell Phone *

Home Phone

Business Phone

Occupation

Parent / Guardian 2 (optional)

Name

Address

Cell Phone

Home Phone

Business Phone

Occupation

Emergency Contacts

At least one required — people to notify if parents are unavailable.

Name *

Relationship *

Phone *

Name

Relationship

Phone

Name

Relationship

Phone

Siblings (optional)

Name

Age

School Attending

Name

Age

School Attending

Name

Age

School Attending

About You

Reasons for Applying to Little Rock Montessori School

Name of Person Referring You (optional)

Agreement

A non-refundable application fee of $200.00 is due with this application, paid directly to the school (not collected online).

Little Rock Montessori School will not discriminate based on race, religion, color, national and ethnic origin, or disability status. Little Rock Montessori School embraces diversity and affords all rights, privileges, programs, and activities available to students and staff at our campuses.

Signature of Parent/Guardian (typed full name) *

Signature of Parent/Guardian 2 (optional)

I certify the information provided in this application is accurate. *