Application for Enrollment - Primary "*" indicates required fields Step 1 of 8 12% InstagramThis field is for validation purposes and should be left unchanged.Student InformationDesired Start Date Month Day Year Date of Birth Month Day Year Full Name* First Middle Last NicknameGenderSelect...MaleFemaleNon-binaryPrefer not to sayOtherPronounse.g. she/her, he/him, they/them Primary Guardian InformationFull Name* First Last Relationship to ChildMotherFatherOtherHome Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneGuardian's Email Address EmploymentEmployerJob TitleEmployer's PhoneIs there another guardian?*Mother, father, etc Yes, add another guardian No, I am the sole guardian Secondary Guardian InformationFull Name* First Last Relationship to ChildMotherFatherOtherHome Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneGuardian's Email Address EmploymentEmployerJob TitleEmployer's Phone Family & SiblingsDoes your child have a second household or split time between two households? Yes No Who has legal custody of this child?If parents are separated or divorced please advise us:Names, Ages & Schools of Family Siblings School InformationHow did you learn about Mead Montessori School?What do you hope your child gains from their time at Mead?Please describe your knowledge of (or experience with) Montessori education.If one or both parents attended a Montessori school, please note that as well. Why do you feel your child would benefit from a Montessori education? What led you to explore this style of education?How long do you plan to remain at Mead?KindergartenLower ElementaryUpper ElementaryMiddle SchoolHas your child previously been enrolled in a Montessori school? Yes No Has your child been in a daycare setting or in someone else's care before? Yes No Please list any prior school/daycare your child has attendedPlease describe your future education plans for your child including elementary and middle school education.If you do not plan to stay through our lower and upper elementary programs, describe your hopes in regards to transitioning from Mead to another school for first grade. Development and Home EnvironmentIs your child biological? Yes, biological No, adopted Other At what age did your child begin walking?In monthsAt what age did your child begin talking?In monthsWhat language(s) are spoken at home?Describe your child's involvement in dressing themselves, including socks and shoes.What does your child’s screen time look like on a daily basis?Is your child fully potty trained? Yes No What language(s) are spoken at home?Mead serves children with a wide range of abilities and skills. We do serve children who have development and/or learning differences as often as we can. However, certain students are best served in environments with integrated therapies and very low adult:child ratios.Issues including but not limited to: • Intellectual disabilities • Moderate-Severe Autism Spectrum Disorder or suspected • Moderate-Severe Attention Deficit Hyperactivity Disorder or suspected • Moderate-Severe Behavioral or Emotional challenges/disorders with or without a diagnosis I acknowledge this policy. Health & Medical InformationHas your child had surgery or any other health complications? Yes No Please describe the surgery, recovery, and any developmental delaysDoes your child have any food or environmental allergies? Yes No Has your doctor prescribed an EpiPen for your child?* Yes No Please specify allergies*Does your child have any special needs? Yes No Is your child under the care of any specialists and/or therapists? Yes No Please describe special needs so that the school may be prepared. Child's Habits & PersonalityWhat are your child's sleeping schedule/habits at home?What are your child's eating schedule/habits at home?What activities does your child enjoy at home? Are there books your child enjoys reading with you?Please describe your child's personalityTuition & Application FeePoint of Contact Responsible for Tuition* First Last Is there more than one point of contact we should include on Tuition information? Yes No Point of Contact Responsible for Tuition First Last Application Fee ($100) Included (Non-refundable)* Yes, included No, will send separately Volunteer OpportunitiesWhen parents share special skills with the school to help support facility and administrative needs, they help in building a larger community of participation and involvement in their child's education. Please indicate the area(s) you would most like to support.I would like to volunteer in the following areas Field trip transportation Illustration Fund raising Outdoor work Sewing Painting Computer help Refreshments for meetings Carpentry Select AllOther volunteer area(s)Parent/Guardian Signature*By typing your full name, you confirm that all information provided is accurate.I hereby verify that the information contained in this document is true and I agree to allow this information to be used for the purpose of evaluation for my child’s application for admission. I also agree to pay the application fee for the processing of this application. Click to agree to the terms and conditions specified herein. Signed byFull NameEmail Date MM slash DD slash YYYY
