The Montessori School at Holy Rosary

Preliminary Application
For Office Use Only
Rec'd App. Fee________________________
Date________________________________
Obs. Date____________________________
Waiting List No________________________
Interview Date________________________
Name of Child: ________________________________________________Birth Date: ____________________Gender:_____
Please Check Program Desired and Indicate Estimated Start Date (Please check only one program)
Primary Montessori:_____
  (3-6 year olds) 8:30 am - 11:30 am

Extended Day:_____
  (5 year olds) 8:30 am - 3:15 pm

Elementary Montessori:_____        Current grade:___               (6-12 year olds) 8:15 am - 3:15 pm   

Elementary Before & After-School:_____
  (6-12 year olds) 7:30 am - 6:00 pm

 All-Day:_____
(3-6 year olds) 7:30 am - 6:00 pm
START DATE:____________________
Name of Father / Guardian: _________________________________________________Home Phone:__________________

Home Address:___________________________________________________________________________________________

Business/Profession: ______________________________________________Work Phone:___________________

Email:______________________________________
Name of Mother / Guardian: ________________________________________________Home Phone:__________________

Home Address:___________________________________________________________________________________________

Business/Profession: ______________________________________________Work Phone:___________________

Email:______________________________________
Education of Father:
Name of
High School:_______________________________________

Continued Educational
Program/Degree:___________________________________

Post Grad:________________________________________
Education of Mother:
Name of
High School:______________________________________

Continued Educational
Program/Degree:___________________________________

Post Grad:________________________________________

The Montessori School at Holy Rosary will not discriminate based upon race, color,
gender, nor ethnic origin.

Please complete both pages of this form and return it to:  12009 Mayfield Road, Cleveland, OH 44106
Name and birth-date of sibling(s):_____________________________________________________________________________

Name(s) of school(s) sibling(s) attend:________________________________________________________________________

Name of applicant's previous school:__________________________________________________________________________

Previous school's address:_________________________________________________________________________________

Dates of attendance at previous school: From: _______________________________To: ________________________________

As parent or guardian of the applicant, I authorize the release of any/all information or records from the above school to The Montessori School at Holy Rosary.

Signature: ________________________________________________________________Date: __________________________

Name of parent/guardian who has observed at The Montessori School at Holy Rosary: _________________________________
(A classroom observation is recommended prior to the applicant's interview for acceptance.)

Is the applicant related to a present or past student of The Montessori School at Holy Rosary? __________________________

If yes, please give the name and applicant's relation to that student: ________________________________________________

How did you first hear about The Montessori School at Holy Rosary? _______________________________________________

Do you understand that the transportation for your child is your responsibility? _______________________________________

We reside in the _______________________________________________________________________ Public School District.

What benefits do you expect your child to derive from a Montessori Education? (Attach another sheet of paper if necessary)

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

We recognize that Montessori Primary is a THREE YEAR program wherein a child normally enters at age 3, remains through age 6, and therefore would not go to another type of "Kindergarten," but would remain at The Montessori School at Holy Rosary until he/she was ready to go on to first-grade or elementary Montessori. If our child is accepted into The Montessori School at Holy Rosary, we agree to utilize the fullness of the program by enrolling for the entire three years.

We recognize that the Elementary Montessori Program is a SIX YEAR program wherein a child normally enters at Grade One and remains through Grade Six. We understand that this six-year cycle is necessary for the child to benefit properly from The Montessori Elementary experience. We are aware that the final decision regarding classroom placement is the sole responsibility of the school.

We understand that if our child is not accepted for admission this year and if we would like him/her to be considered for the following year, we are to notify The Montessori School at Holy Rosary by mid-year to reactivate this application (at no additional charge).

An application fee of $35.00 for Primary-age students or $50.00 for Elementary-age students is required.

Authorized signature
of Parent/Guardian: ___________________________________________________________________Date: _______________

To whom should correspondence be addressed? Please list the name(s) and title(s) as you would like them to appear on all correspondence:

Name (s): ______________________________________________________________________________________________

Address: _______________________________________________________________________________________________