Grade:


Student's Age in September:


School Year (20--20):


Recent Photograph (upload):

STUDENT INFORMATION

Full Name (As it should appear on school records):


Social Security Number:


Gender:
MaleFemale

Date of Birth (MM/DD/YY):


Place of Birth:

PARENT/GUARDIAN INFORMATION

Student lives with:
MotherFatherParents separatedParents divorcedStepmotherStepfatherOther

Correspondence should be addressed to:
MotherFatherOther

Tuition will be paid by:
MotherFatherOther

Mother's Information

Full Name:


Address:


Mobile:


Email:


Employer:


Position:

Father's Information

Full Name:


Address:


Mobile:


Email:


Employer:


Position:

EMERGENCY CONTACT

Other Contact Name:


Relationship:


Address:


Mobile:


Email:

SCHOOL HISTORY

Present School:


Address:


Enrolled Since:


Previous Schools (Include grades and years attended):

HEALTH HISTORY

General Health Description:


Any physical handicaps or allergies? (Yes/No):
YesNo

Describe if Yes:


Serious Injury or Illness? (Yes/No):
YesNo

Describe if Yes:


Under care of physician, psychiatrist, or psychologist? (Yes/No):
YesNo

Doctor's Name:

ADDITIONAL INFORMATION

What appeals to you about Kingswood Montessori Academy?


Describe your child's learning style:


Academic strengths and weaknesses:


Social adjustment:


Activities and hobbies:


Primary language spoken at home:

PHOTO/NAME CONSENT

Can your child's photo/name be used in school publications? (Check all that apply):
School NewslettersSchool YearbooksAdvertisementsOther Publications

AUTHORIZATION

Parent/Guardian Signature:


Date: