Lor-Jon Montessori School

Lor-Jon Montessori School

2015/16 Application for Admission

I, ______, hereby make an application for admission of ______

as a pupil at the Lor-Jon Montessori School for the academic term beginning September 2015 or (M/Y) ______

and ending June 2016.

The following information is submitted as part of this application:

Child’s date of birth M/ ______D/ ______Y/ ______Sex M _____ F _____

Home Address______Telephone # (____) ______

______

Father’s name ______Address if different from student ______

______

Occupation______Name and address of employer ______

Work phone # (____) ______

Cell phone # (____) ______

E-Mail address______Religion ______Nationality ______

Mother’s name ______Address if different from student ______

______

Occupation______Name and address of employer ______

Work phone # (____) ______

Cell phone # (____) ______

E-Mail address______Religion ______Nationality ______

Child’s physician______Telephone (____) ______

Address ______

Does your child have any allergies ? Y/N If yes, please specify______

Persons to be called in case of emergency if a parent cannot be reached?

______Home # (____) ______Cell # (____) ______

______Home # (____) ______Cell # (____) ______

If neither parent can be contacted, I authorize the school administration to take such emergency action as deemed necessary.

Names of people, other than parents who are authorized to pick up my child from school:

______Home # (____) ______Cell # (____) ______

______Home # (____) ______Cell # (____) ______

______Home # (____) ______Cell # (____) ______

Names and ages of siblings ______

Has your child attended a pre-school or kindergarten before? Y/N Where? ______

I authorize the school to allow my child to be taken outside for supervised outdoor activities.

Parents Signature ______Date ______

______

I/we understand that children are admitted for the full academic year and that I/ we are responsible for the tuition for the full 2015-2016academic year, or that portion of the academic year following my child’s date of withdrawal. I/we are also responsible for full monthly payments even if days are missed due to school vacations, personal vacations, illness, or dismissal from school for any cause after the date of admission.

(OVER)

Tuition and Fees for the 2015-2016 Academic Year:

Registration fee: $75.00 per student. Please note that this fee is non-refundable.

Monthly Tuition: (Please circle an option i.e. OPTION 3- 4 days/week)

OPTION 1: AM EXTENDED DAY(3-6year old classes only)

**9AM-230PM (LUNCH/RECESS 12nn-1PM)

3 A.M. sessions w/ 3 A.M. sessions w/ 3 A.M. sessions w/ 4 A.M. sessions w/ 5 A.M. sessions w/

1 extended day/week 2 extended days/week 3 extended days/week 4 extended days/week 5 extended days/week

$485/month $510/m $535/m $595/m $655/m

OPTION 2: PM EXTENDED DAY(3-6year old classes only)

**1PM-6PM

3 A.M. sessions w/ 3 A.M. sessions w/ 3 A.M. sessions w/ 4 A.M. sessions w/ 5 A.M. sessions w/

1 extended day/week 2 extended days/week 3 extended days/week 4 extended days/week 5 extended days/week

$485/month $510/m $535/m $595/m $655/m

OPTION 3: AM SESSION (TODDLER AND 3-6year old classes)

**9AM-12NN

3-6YEAR OLD TODDLER(2 year-olds)

3days/week 4days/week 5days/week 2days/week 3days/week 4days/week

$430/month $455/m $480/m $420/month $445/m $470/m

OPTION 4: PM SESSION (3-6year old classes only)

**1PM-4PM

3days/week 4days/week 5days/week

$430/month $455/m $480/m

Please circle the days of the week you would like your child to attend. M T W Th F

Early Drop-Off- M T W Th F

Extended Day - M T W Th F

Tuition is paid in nine equal payments, September-May.

The registration fee and the first month’s tuition are to be paid before the first day of school. Please note that the registration fee is separate from tuition and cannot be deducted from the first month’s tuition. Monthly tuition payments are due on the first of the Month or on the first day of the month that your child attends. A $20.00 late fee for all payments received after the 10th of the month. The monthly tuition may be adjusted for a child starting in the middle of the month.

I/we understand that I may withdraw this application providing I give written notice to the administration of Lor-Jon Montessori School thirty days prior to my child’s scheduled entry. I/we understand that the $75.00 registration fee is non-refundable.

Each family will receive a school calendar and a Lor-Jon Montessori Handbook. By signing this application, you affirm that you will abide by the guidelines set forth in the handbook.

I/we grant permission for the use of photographs or digital images in which my child may appear to be used for educational and public relations purposes, such as articles in the paper, slides, films, or the school website

Health Forms : All new students MUST have a current health form on file prior to the start of school. Please inform us of any allergies your child may have on the front page of this form and in the parental questionnaire. All Kindergarten children MUST provide an updated health form AND proof of a dental exam.

I/we agree in consideration of the acceptance of my child as a student of Lor-Jon Montessori School, to indemnify the school, administration, and staff against any claims and demands made by or on behalf of my child ______.

______

Signature of parent or guardian Date Signature of parent or guardian Date

Note : 2 days a week is only available to toddlers. All 3-6 year-old children must attend either a Monday or a Friday

Application received ______Registration Received ______Check # ______Amount ______