Early Childhood Application

Please carefully complete the following application for admission. A non-refundable application fee of $100 is required to secure your spot on our waiting list. This fee is a one-time fee per child and can be applied to a future application if enrollment does not occur during the first eligible enrollment season.

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Student Information

Desired Start Date

Month

Day

Year

Date of Birth

Month

Day

Year

Full Name*

First Last

Nickname

Gender

Pronouns

e.g. she/her, he/him, they/them

Primary Guardian Information

Full Name*

First Last

Relationship to Child

Mother

Father

Other

Home Address

Street Address City State ZIP Code

Home Phone

Cell Phone

Employer

Job Title

Employer's Phone

Is there another guardian for this child?*

Yes, add another

No, I am the sole guardian

Secondary Guardian Information

Full Name*

First Last

Relationship to Child

Mother

Father

Other

Home Address

Street Address City State ZIP Code

Home Phone

Cell Phone

Employer

Job Title

Employer's Phone

Family & Siblings

Does your child split time between households?

Yes

Who has legal custody of this child?

First Last

If parents are separated or divorced, please provide relevant details.

List siblings (name, age, school), one per line.

School Information

How did you learn about Mead Montessori School?

What do you hope your child gains from their time at Mead?

Describe your experience with Montessori, why you chose it, and any family background with it.

How long do you plan to remain at Mead?

Has your child previously been enrolled in a Montessori school?

Yes

Has your child been in a daycare setting or in someone else's care before?

Yes

Please list any prior school/daycare your child has attended

Please describe your future education plans for your child, including elementary and middle school, and your hopes for transitioning from Mead if you do not plan to stay through our programs.

Development and Home Environment

What is your relationship to the child?

Biological

Adopted

Other

At what age (in months) did your child begin walking?

At what age (in months) did your child begin talking?

What 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

Emergency Contact (Non-Parent)

Name

First Last

Phone

Relationship to Child

Health & Medical Information

Has your child had surgery or any other health complications?

Yes

Please describe the surgery, recovery, and any developmental delays

Has your doctor prescribed an EpiPen for your child?*

Yes

Please specify allergies*

Does your child have any special needs?

Yes

Is your child under the care of any specialists and/or therapists?

Yes

Please describe special needs so that the school may be prepared.

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.

Child's Habits & Personality

What 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 personality

Tuition & Application Fee

Point of Contact Responsible for Tuition*

First Last

Is there more than one point of contact we should include on Tuition information?

Yes

Additional Point of Contact Responsible for Tuition

First Last

Application Fee ($100) Included (Non-refundable)*

Yes, included

No, will send separately

Volunteer Opportunities

When 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.

Please indicate areas where you would like to volunteer.

Field trip transportation

Illustration

Fund raising

Outdoor work

Sewing

Painting

Computer help

Refreshments for meetings

Carpentry

Other volunteer areas (please describe)

Signature

By typing today's date, your full name and email, you confirm that all information provided is accurate.

Date

Full Name

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.

Early Childhood Application

Student Information

Primary Guardian Information

Secondary Guardian Information

Family & Siblings

School Information

Development and Home Environment

Emergency Contact (Non-Parent)

Health & Medical Information

Child's Habits & Personality

Tuition & Application Fee

Volunteer Opportunities

Signature

Details

Weekdays

Weekends

Location & Physical Address

Contact Us

Mead Montessori School Founded 2008

Phone: (865) 577-0760

email: info@meadmontessorischool.com