Casa-Dei-Bambini Montessori

Registration Form

Child’s

Name___________________________________________________Phone________

________

Address_______________________City____________State_____________Zip___

_____________

Date of Birth ______________Age on Sept. 1,

20……._____________Sex_______________

Father’s Name ______________Occupation Employer

__________Phone________________

Mother’s Name______________

Occupation_____________________Phone________________

Emergency Contact______________________________ ____________ _Phone

_______________

Address of Emergency

Contact___________________________________________________

Are Parents divorced? _________________Who has custody?

______________________

Brothers and sisters of the child:

Name Age School Grade

1.

_______________________________________________________________________

____________

2.

_______________________________________________________________________

____________

3.

_______________________________________________________________________

_____________

Relatives others living in the home:

Name ______________________________ Relationship

_________________________________

Medical History

Is your child allergic to anything?____ If so, please specify both the

items and necessary

Treatment

_______________________________________________________________________

_____

Has your child had vision problems?

________________________________________________
Does your child has frequent ear infection?

________________________________________

Does your child have tubes in his/her ears?

________________________________________

Does your child listen to the television on a high volume?

________________________

Has your child had a speech exam? _______

Results_______________________________

List all surgeries, injuries, and hospitalizations

Date Incidents

_______________________________________________________________________

__________________

_______________________________________________________________________

__________________

_______________________________________________________________________

__________________

Personality Assessment

Describe your child’s special

interests:______________________________________________________

Describe any unusual

behavior_____________________________________________________________
Child’s

Name________________________________________________________________________

__________

Please indicate below the session to which you are applying by putting 1 by

your first choice. If you are willing to accept a different time slot, put a 2 by

your second choice, etc.

TUITION:

Wobblers class (12 months through 24 months) Yearly

10 Payments

___Tues, Wed, Thur. 9:00 am to 12:00 pm

$5,950.00 $595.00

____ Tues, Wed, Thur. 9:00 am to 3:00 pm

$7,500.00 $750.00

____Monday to Friday 9:00 am to 12:00 pm $6,750.

00 $675.00

____Monday to Friday 9:00 am to 3:00 pm

$8,000.00 $800.00

Transitional class (24 months through 36 months)

____Tues, Wed, Thur 9:00 am to 12:00 pm $

5,950.00 $595.00

____Tues, Wed, Thur 9:00 am to 3:00 pm

$7,500.00 $750.00
____ Monday to Friday 9:00 am to 12:00 pm

$6,750.00 $675.00

____ Monday to Friday 9:00 am to 3:00 pm

$8,000.00 $800. 00

3 Years to 6 years class

___P1 Monday to Friday 9:00 am to 12:00 pm

$6,200.00 $620.00

___P2 Monday to Friday 9:00 am to 3:00 pm

$8,000.00 $800.00

___P3 Monday to Friday 9:00 am to 3:00 pm

$8,000.00 $800.00

___P4 Monday to Friday 9:00 am to 3:00 pm $8,000.

00 $800.00

A yearly activity fee of $400.00 for kindergarten students is paid per

semester per child in the amount of $200.00 each semester. This fee is

due in August and January at the school year.

EXTRA HOURS: Before and after school are available.

___6:30 am to 9:00 am $70.00 per month

___3:15 pm to 6:30 pm $100.00 per month

Registration and Security Deposit:

There is a yearly registration fee of $125.00 per student and $200.00

per family with 2 or more sibling. This fee is due at the time of

application, and once the space is offered and accepted, the fee

becomes non-refundable. Tuition

may be paid in ONE yearly payment or TEN equal installments starting

in August and continuing each month through May. Parents agree and

understand that they are responsible for the entire monthly payment,

regardless of the number of days absent. A fee of $35.00 will be

charged on all returned checks. Payments received after the 5th of the

month for 2 or more months will be charged a late fee of $10.00.

The child should love everything he learns. Whatever is

presented to him must be made beautiful and clear. Once
this has been kindled, all problems confronting the
educationalist will disappear.

Maria Montessori