Unitarian Society Montessori School 176 Tices Lane, East Brunswick , NJ 08816 (732) 246-0606 APPLICATION FOR ADMISSION (please print) Toddler (18 months - 3 years) |
| Name of Student ____________________________________________________________________________ Address ___________________________________________________________________________________ Home Phone ( )_____________________Sex________ Age________ Date of Birth ____________________ Email Address: ______________________________________ Father's Name ______________________________________ Business Phone___________________________ Business Name _______________________ Business Address______________________________________ Occupation _________________________ SS#______________________ Cell Phone______________________ Mother's Name ______________________________________ Business Phone___________________________ Business Name _______________________ Business Address______________________________________ Occupation _________________________ SS#______________________ Cell Phone______________________ Marital Status________________ Children Living With __________________ Other Children in the Family (Names and Ages) __________________________________________________ Is there any medical, environmental, or behavioral history that would be useful in helping to understand your child? ________________________________________________________________________________________ Child’s Pediatrician ________________ Phone ______________________ Address _______________________________________________ Emergency Contact ____________________Phone_________________ Please indicate your choice for number of days and hours needed: Enter AM, PM, or FULL in the blanks below: ______ 5 Days ______ 3 Days M-T-W (confirmed after April 30th) ______ 2 Days TH-F (confirmed after April 30th) Will you need extended hours daycare? Yes _____ No_____ If Yes, AM (7-9) _____ PM ( 3:30-6:30 ) _____ Signature__________________________________________________________________Date___________ |