Application

School Year *

Program *

Child Information

Child's Name *

First

Middle

Last

Date of Birth *

Gender *

Male
Female

Previous Montessori Experience

Siblings of Child

First names & age

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent or Guardian 1

Name *

First

Last

Phone *

Phone

Mobile

Email Address *

Email Address

Profession

Address *

Same as child
Different address

Parent/Guardian Address 1 *

Address Line 1

Address Line 2

City

State

Zip Code

Parent or Guardian 2

Name *

First

Last

Phone *

Phone

Mobile

Email Address *

Email Address

Profession

Address *

Same as child
Different address

Parent/Guardian Address 2

Address Line 1

Address Line 2

City

State

Zip Code

Additional Information

Previous School Experience of Child

School Name & Address, Date Attended

Please provide any other pertinent information that would help us better serve your child’s needs, such as allergies, on-going therapies (if any), and other health issues. You may attach extra pages, if necessary: *

Agreement

A non-refundable application fee of fifty dollars ($50.00) is required for admission consideration.

Please make your checks payable to Mosaic Montessori Academy, or send a QuickPay/Zelle payment to info@mosaicmontessori.org.

For questions, please call 708.834.3099 / 312.351.0074 or email us at info@mosaicmontessori.org

Thank you for your interest in Mosaic Montessori Academy.

Notice of non-discriminatory policy as to students

Mosaic Montessori Academy (MMA) admits students of any race, color, religion, nationality, & ethnic origin, and accords them all the rights, privileges, programs, and activities generally made available to all students enrolled at MMA. It does not discriminate on the basis of race, color, religion, nationality, & ethnic origin, in the administration of its admission & educational policies.

Signature of Parent or Guardian *

You may use a mouse or your finger to sign.

Date of Signing

Checkboxes *

All the information that I have provided in this application form are true, accurate, and to the best of my knowledge

Checkboxes *

I understand that a non-refundable fee of $50 is required to process this application for admission (see payment options above).

How it works:

Student Admissions Application

Child Information

Parent or Guardian 1

Parent or Guardian 2

Additional Information

Agreement

A non-refundable application fee of fifty dollars ($50.00) is required for admission consideration.

Notice of non-discriminatory policy as to students

Montessori Affiliation

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