“All sections must be answered by parents of children already born while parents of unborn children may mark those questions as NA(Not Applicable) that they do not know answers for”

Child’s Full Name First *

Preferred Name

Sex *

Date of birth (or Due Date) *

Birthplace *

Child's Address *

Preferred Enrollment Date *

How flexible are you with this date

Interview date (for Office use only)

Infant enrollment

Schedule A: 8:30am to 5:30pm, M-F

Toddler enrollment

Schedule A: 8:30am to 3:00pm, M-F

Schedule B: 8:30am to 5:30pm, M-F

Primary enrollment

Schedule A: 8:30am to 5:30pm, M-F

Schedule B: 8:30am to 3:00pm, M-F

Schedule C: 8:30am to 1:00pm, M-F

Additional program schedules needed

Early Bird program 7:00 am to 8:00 am(Primary):

Early Bird program 7:00 am to 8:30 am(Toddler & Infant):

Previous school/Childcare

Location

Duration

Parent 1 First Name *

Parent 1 Last Name *

Parent 1 Address *

Email *

Phone *

Parent 2 Name

Parent 2 Address

Parent 2 Email

Parent 2 Phone

Decatur Montessori School has a non-discriminatory policy relative to race, color, family structure or national origin with respect to the admission of students and the employment of faculty and administrative staff.

Decatur Montessori School considers the records of all individual students to be confidential information available to a child's parents or guardians upon request. Records will only be released to other schools or agencies upon signed request from a parent or guardian and only after all accounts are paid in full.

Submit application and non-refundable fee of $100 to Decatur Montessori School, 1429 Church St., Decatur, Georgia 30030.

QUESTIONNAIRE

PHYSICAL DEVELOPMENT

1. Were there any prenatal/birth difficulties?

If yes, please specify

2. When did your child sit up?

crawl?

walk?

NA

3. Is there anything that concerns you about your child's motor development?

If yes, please specify here

4. Does your child speak?

if Yes, please answer the questions, When did your child start speaking single words?

Sentences?

Is there anything that concerns you about your child's speech?

If yes, then please specify:

5. Is your child exposed to other languages other than English?

If yes, please specify language

6. Has your child ever had a hearing test?

If yes, what result

7. Has your child ever had a vision test?

If yes, then what result

8. Has your child ever had a serious illness or accident?

If yes, specify here

EATING

1. Does your child eat well? *

2. Does he/she eat on his own or must be fed? *

3. Does your child eat with *

Spoon

Fork

Hands

NA

TOILET HABITS (

1. Is your child independent in the bathroom? *

Please review the checklist below to help determine your child’s readiness: *

Only wears pull-ups

Only wears underwear

Initiates or expresses bathroom needs

Can wipes independently

Able to dress themselves

NA

SLEEPING

1. Does your child have regular sleeping schedule?

2. What time does your child go to bed?

3. What time does your child wake up?

4. Does your child sleep in his/her own bedroom?

5. Does your child take naps?

If yes, please specify:(from____to____ )

6. Does your child need help falling asleep?

If yes, please specify need:

7. Does your child need pacifier or other comfort item to sleep/comfort?

PERSONALITY

1. How would you describe your child's personality?

Friendly

Aggressive

Shy

Withdrawn

NA

2. How does she get along with his/her siblings?

3. Does your child like to:

Be read

Listen to music

Play outdoors

NA

4. Has your child had experience with:

Clay

Scissors

Blocks

Easel painting

Water play

Finger painting

NA

5. How does your child play?

Alone

With other children

With adults

NA

6. How does your child express emotions?

Verbally

Physically

Both

NA

7. How does your child respond to direction?

8. What methods of discipline do you use? Please elaborate

How effective are they?

9. What makes your child upset or uncomfortable?

FAMILY LIFE

1. Are both parents living at home?

2.Have you moved recently?

3.Who, besides the parents, regularly cares for the child?

4.What group experiences has your child had?

5.What does your family do for fun together?

6. What are the names, ages and schools of other siblings, cousins etc in the family?

7. Does your child watch television or video tapes?

If yes, how often and for what length of time?

PREVIOUS SCHOOL EXPERIENCE

Has your child attended another school, daycare center, or family daycare home?

If yes, where and when?

YOU AND THE SCHOOL

1. Are you familiar with the Montessori approach?

If yes, what aspects of the Montessori environment do you think are most valuable?

2. Are you planning for your child to complete the curriculum at Decatur Montessori School before moving to another program? (children usually complete their curriculum around age 6/7)

3. What options besides Decatur Montessori are you considering? What do you find most appealing about our programs?

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