ELEMENTARY Student Keystone Montessori School Application
Student's Information
Full Name
*
Nickname
Child's Date of Birth
*
Student's Gender
*
Male
Female
Non-Binary
Home Phone
*
Home Address
*
City, State, Zip
*
Applying For
*
Lower Elementary (Grades 1 - 3)
Upper Elementary (Grades 4 - 6)
When do you want to start?
the 2024 - 2025 school year
the 2025 - 2026 school year
I’m not sure yet/other
Parent/Guardian 1
First Name
*
Last Name
*
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 school experience?
Yes
No
School
Date of Enrollment
City, State
Teacher
School
Date of Enrollment
City, State
Teacher
Describe your child’s previous school or daycare experience.
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 medications?
*
Has your child had any developmental screenings, neuropsychological testing, or evaluations?
*
Yes
No
Has your child ever participated in Early Intervention?
*
Yes
No
Has your child ever been evaluated by a speech therapist?
*
Yes
No
Does your child have an IEP?
*
Yes
No
If yes, please describe and forward a copy of the results to us:
Does your child have a history of: (Please check all that apply)
Shyness
Twirling or spinning
Nail biting
Thumb sucking
Restlessness
Fear of darkness
Temper tantrums
Eating issues
Trouble with gross motor skills
Sensitivity to textures
Daydreaming
Resenting discipline
Hair twisting/pulling out hair
Excessively focused on specific interests
Frequently repeating words
None of the above
Does your child watch TV?
*
Yes
No
If so, what duration/frequency?
Does your child play video games?
*
Yes
No
If so, what duration/frequency?
Does your child use a tablet or smartphone?
*
Yes
No
If so, what duration/frequency?
How old was your child when they began watching TV?
How old was your child when they began playing video games?
Is your child toilet trained?
*
What else would you like Keystone to know about your child? (napping or eating habits, things they enjoy, characteristics, etc.
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