APPLICATION for ADMISSION

Lakeshore Montessori

2100 NW 99^th Street

Vancouver, WA 98665

(360) 573-4103

Attach Child’s photo

2007 - 2008 APPLICATION for ADMISSION

Child’s name ______________________________________________________________________

First middle last usually called

Home Address ____________________________________________ Phone___________________

Street City zip

Male ______ Female ______ Date of Birth ___________________ Social Security___________________

Mother’s/Guardian’s name ___________________________________ Social Security _________________

Home Address________________________________________________ Home Phone___________________

(if different from student)

______________________________________________________________ Cell Phone__________________

City State zip

Email Address_____________________________ Occupation________________________________

Place of Employment________________________________________ Business Phone_________________

Father’s/Guardian’s name ___________________________________ Social Security __________________

Home Address________________________________________________ Home Phone___________________

(if different from student)

______________________________________________________________ Cell Phone_______________

City State zip

Email Address___________________________ Occupation________________________________

Place of Employment______________________________________ Business Phone_______________

If parents are separated or divorced, please answer the following:

With whom does the applicant live?____________________________________________________

Who is the legalguardian?_____________________________________________________________

To whom should bills besent?__________________________________________________________

To whom should mailings be sent?______________________________________________________

If remarried, stepmother/stepfather name:______________________________________________

List other children in Family:

Name_______________________________ Age_________ Sex_________

*************************************************************************************************************

I am interested in informal child care Yes______ No________

Are you familiar with the Montessori method of teaching and learning? (circle) Yes No Somewhat

Please return this completed application with the non-refundable application fee of $50.00

Parent/guardian Signature________________________________________ Date______________

Lakeshore Montessori admits students of any race, color, disability, religion, sexual orientation, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admission policies, and other school-administered programs