BEGINNERS Student Keystone Montessori School Application
Student's Information
Student’s Full Name
*
Nickname
Child's Date of Birth
*
Student's Gender
*
Male
Female
Non-Binary
Home Phone
*
Home Address
*
Student's City, State, Zip
*
BEGINNERS Applying For
*
Beginners' Program - Infant (3 mos. through 15 months)
Beginners' Program - Toddler (15 months through 2 years 9 months)
When do you want your Beginners' child to start?
*
the 2025 - 2026 school year
I'm not sure yet, other
Parent/Guardian 1
First Name
*
Last Name
*
Parent/Guardian 1 - Relationship to Child
*
Address
*
City
*
State
*
Postal code
*
Parent/Guardian 1 - Daytime Phone
*
Parent/Guardian 1 - Cell Phone
*
Parent/Guardian 1 - Evening Phone
Parent/Guardian 1 - Employer
*
Email
*
Parent/Guardian 2
Full Name
Parent/Guardian 2 - Relationship to Child
Parent/Guardian 2 - Address
Parent/Guardian 2 - City
Parent/Guardian 2 - State
Parent/Guardian 2 - Zip
Parent/Guardian 2 - Daytime Phone
Parent/Guardian 2 - Cell Phone
Parent/Guardian 2 - Evening Phone
Parent/Guardian 2 - Employer
Parent/Guardian 2 - Email
Siblings
Name
Date of Birth
Current School
Name
Date of Birth
Current School
Family Status
Family Status:
Married
Divorced
Separated
Single Parent
Life Companions
Widow(er)
Person(s) financially responsible for tuition and expenses (if different from above)
Address
City, State, Zip
Phone Number
Email
Does your child have previous experience with daycare or care outside immediate family? If yes, please explain.
*
Why do you think Keystone Montessori would make a good choice for your child?
*
How long do you envision keeping your child enrolled at Keystone?
How would you describe your child?
*
Describe your child’s general health. Any allergies?
*
Has your child ever suffered any serious illness or hospitalizations? If yes, please describe.
*
Is your child currently taking any routine medications?
*
Has your child had any developmental screenings, neuropsychological testing, or evaluations?
*
Yes
No
Has your child ever participated in Early Intervention?
*
Yes
No
If yes, please describe what type of services.
Does your Beginners' child have a history of: (Please check all that apply)
*
Shyness
Twirling or spinning
Nail biting
Thumb sucking
Restlessness
Fear of darkness
Eating issues
Trouble with gross motor skills
Hair twisting, pulling out hair
Sensitivity to textures
Sensitivity to light
Sensitivity to noises
None of the above
What milestones has your child met?: (Please check all that apply)
*
Rolling
Pulling up, cruising
Sitting independently
Walking
Introduction to solid foods
First tooth
First word(s)
Have you begun any toileting with your child? Please describe.
*
Does your child watch TV?
*
Yes
No
If yes, how old was your child when they began watching TV?
Do you have a coupon code?* (if you are applying now for a second/third child in your family)
*
Yes
No
No elements found. Consider changing the search query.
List is empty.
Please enter your coupon code.
Parent/Guardian 1 Signature
*
Clear
Date
*
Parent/Guardian 2 - Signature
*
Clear
Date
*
Yes