Reach Montessori Preschool
2490 Story Rd. San Jose CA 95122
(408)272-8888
Enrollment Application
Child’s Name: ______________________________________________________________
First Middle Last
Date of Birth: ______________________________________ Please Circle (Boy) or (GIRL)
Home Address: _________________________________________________________________
Home Phone Number: _______________________________
Special Considerations: ___________________________________________________________
PLEASE SELECT A PROGRAM:
Toddler Program ( ) 8:00-6:00pm M-F, M W F, T Tu( ) 8:00-12:00pm ( )12:30-6:00pm
Preschool Program ( ) 8:00-6:00pm M-F, M W F, T Tu( ) 8:00-12:00pm ( )12:30-6:00pm
Kindergarten Program( ) 8:00-6:00pm M-F, M W F, T Tu( ) 8:00-12:00pm ( )12:30-6:00pm
Program: ____________________Potty Training need ( ) yes ( )no
| Father’s Name: ______________________________ Cell Phone: ________________________
Employer Name: _____________________________ Work Phone: _______________________ Business Address_____________________________ Email: ____________________________ Social Security # _____________________________ Drivers License: ______________________ Does Father live with the child? ( ) Yes ( ) No Mother’s Name: _____________________________Cell Phone: _________________________ Employer Name: _____________________________Work Phone: ________________________ Business Address_____________________________Email: _____________________________ Social Security # _____________________________ Drivers License: ______________________ Does Mother live with the child? ( ) Yes ( ) No |
All enrollment applications are subject to approval and space is not guaranteed until a registration fee has been paid and the enrollment application has been signed.
I/We have received the Parent Handbook ______________Parent Initial
Parent 1 Signature_______________________________Date___________________________
Parent 2 signature______________________________ Date___________________________
| For Office Use: Starting Date: _____________ Classroom_______Registration Fee $__________CK #________ CK Date_______ |