ONLINE ENROLLMENT FORM Enrollment Application Enrollment Application 1Personal Information2Family Background3Child Needs Assessment Student Name* First Last Gender* Male Female Date of Birth* MM slash DD slash YYYY Age in years/months* Montessori School Duration Pre School Duration Other Duration Parent's/Guardian's SignatureDate: MM slash DD slash YYYY Reason for applying to Sienna Montessori School: Mother or Guardian First Last Home Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Place of Employment/Occupation/Position Home PhoneWork PhonePager/Cell Social Security Driver's License Number Email Address Father or Guardian First Last Home Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Place of Employment/Occupation/Position Home PhoneWork PhonePager/Cell Social Security Driver's License Number Email Address Marital Status of Parents Sienna Montessori School may request previous school records and further reserves the right to withhold records of withdrawing students until all accounts are paid in full.SiblingsNameAge GrandparentsNameAge Custody Visiting Arrangements The following information will enable us to know your child better.If child is adopted, list age at adoption: Is your child toilet trained? Yes No Describe assistance and words used:Does your child naps? Yes No What time? What time does your child go to bed at night? What time does your child wake up? Does your child have any special fears? Does your child have any problems with vision? Yes No If yes, please describe:Does your child have any health problems that we should be aware of? Yes No If yes, please describe:Are there any foods or drinks that your child should not have? Yes No If yes, please describe:Do you have any concerns about any aspect of your child’s development? Yes No If yes, please explain: Crawls on hands and knees Sits Alone Walks Name Simple Objects Speaks in Complete Sentences Sleeps through the night Do you feel your child’s speech is clear? Yes No Can strangers understand when he or she speaks? Yes No Is any language other than English used in the home? Yes No If yes, please list: List illnesses your child has had Does your child have frequent: Colds Earaches Nosebleeds Sore Throats Stomachaches Fever Has your child had any serious accidents or operations? Yes No If yes, please describe:Does your child take any regular medication? Yes No If yes, please list:When was your child last to a doctor? Dentist? Are there any special medical, physical, or emotional needs that the school or staff should be aware of?Medical: Physical: Emotional Needs: How much television does your child generally watch each day?Hours Minutes How much computer time does your child have weekly?Hours Minutes What are your child’s favorite activities?What does your child enjoy doing with mother?What does your child enjoy doing with father?Does your child play well alone? Yes No In groups? Yes No Are there neighborhood playmates? Yes No If yes, what age children does your child usually play with?Does your child accept correction easily? Yes No If no; please explainWhat is the method of behavior control used in your home?Please check items below that describe your child… Happy Aggressive Friendly Moody Clumsy Dependent Stubborn Impulsive Fearful Quiet Good-Natured Even-Tempered Attentive Sympathetic Shy Sleepy Inquisitive Highly-observant Love Music Verbal Has your child learned to…Say Nursery rhymes? Yes No Sing Songs? Yes No Listen to Stories? Yes No Say his or her name? Yes No State his or her age and sex? Yes No Count Yes No Recognize and name common objects? Yes No Dress Independently? Yes No Follow simple directions? Yes No Name basic colors? Yes No Hop on one foot? Yes No Ride a tricycle? Yes No Write Name Yes No Draw a Person Yes No Has your child been cared for by someone besides the family? Yes No If Yes, Please describe:What are your educational goals for this child? How do you see Sienna Montessori facilitating these goals?What do you hope will be included in your child’s program?If you had a choice, what would you volunteer to do for the school? (You do not have to be at school to volunteer) Δ Summer Programs Infant Room Lower Elementary Primary Room Transition Room Toddler Room Youth Club 2020-2021 Calendar Events SMS 2020-2021 CALENDAR EVENTS Welcome to Sienna Montessori School
