Pearlily Montessori Preschool & Kindergarten - Application for Admission - Authentic Montessori Preschool and Kindergarten in Dublin, Ohio

Child's Name *

First

Last

Birthdate *

Gender *

Male
Female

When would you like your child to start at Pearlily? *

Right away
In a few weeks
Within the next 2-3 months
Next school year

Has your child, or any of your other children, ever attended a Montessori preschool before? *

How would you characterize your level of familiarity with the Montessori method and philosophy? *

Not familiar at all
Have some understanding about the method
Very familiar about the approach and know the benefits
Extremely familiar and completely understand the philosophy

Does your child have any allergies (including medication reaction)? *

Please explain your child's allergies. *

Does your child have any special disabilities? *

What are your child's special disabilities? *

If your child has a special condition or takes any medications, please explain. Otherwise, please indicate NA. *

In the event of an emergency, are there any medical or dietary information we should know about? *

Does your child have any other special needs? If not, please indicate NA. *

Parent Information

Mother's Name *

First

Last

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mother's Phone *

Mother's Email *

Mother's Employer *

Father's Name *

First

Last

Father's Address (if different from above, otherwise skip)

Address Line 1

Address Line 2

City

State

Zip Code

Father's Phone *

Father's Email *

Father's Employer *

Parents' Marital Status *

Married
Divorced
Single
Widowed

Who has legal custody? *

Mother
Father
Both Mother and Father
Legal Guardian

May the non-custodial parent pick up the child? *

Pearlily Montessori must be provided with court issued custody papers that clearly describe the custody arrangements. Any person granted custody in such papers may pick up the child during the times that person has custody, and that person may designate other persons as authorized to pick up the child at such time unless court papers state otherwise. NOTE: THE CHILD WILL BE RELEASED ONLY TO THE ENROLLING PARENT OR GUARDIAN, AND THE PERSON OR PERSONS AUTHORIZED BY THE PARENT ON THIS FORM. IF NEITHER PARENT OR GUARDIAN, NOR EMERGENCY CONTACTS ARE AVAILABLE, ENROLLING PARENT AUTHORIZES SCHOOL PERSONNEL TO USE THEIR BEST JUDGMENT TO CARE FOR THE CHILD.

Primary Residence of Child *

Mother
Father
Both Parents (same household)
Legal Guardian

Address of Legal Guardian *

Address Line 1

Address Line 2

City

State

Zip Code

Person to Whom Child May Be Released

Trusted Person's Name *

First

Last

Trusted Person's Relationship to Child *

Trusted Person's Phone *

Local Emergency Contact Person

Must be someone not living with you.

Emergency Contact's Name *

First

Last

Emergency Contact's Relationship to Child *

Emergency Contact's Phone *

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I've read and understood Pearlily Montessori's Privacy Policy.

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