Admissions

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Fields marked with a * are required.

Child's Full Name *

Gender *

Male
Female

Birthday *

Application Start Date *

Primary Guardian's First Name *

Primary Guardian's Last Name *

Email *

Phone Number *

Address *

City *

Zip / Post Code *

Occupation *

Employer or Business *

Business Phone

Second Guardian's Name

Second Guardian's Phone Number

Siblings

Which Program will your child be enrolled in? *

Toddler Program (2 years)
Preschool - Kindergarten (3-6 years)

Application Fee - An application fee of $100.00 must accompany this application for admission. Prior to enrollment, this fee will secure a place on our waiting list for your child. Upon enrollment, this fee will cover registration, processing fees, materials and supplies. THE APPLICATION FEE IS NON-REFUNDABLE.

Wait List - If you are applying for a program that is currently full, the application fee is still due with this application. The fee will secure your child a place on our wait list. If we are unable to accept your child, this fee will be returned to you in full.

Is your child... (check all that apply) *

allergic to any foods, medications, insects, or animals, etc
on a special diet
unable to participate in physical education
under a physician’s care for a particular problem
on medication on a consistent basis
receiving any type of therapy at this time
a pre-term baby
none of the above

Please explain any of the options you checked above.

Have there been any difficulties or crises in your family such as accidents, medical problems, etc., that may have affected the emotional well-being of your child? (If yes, Please explain): *

What are some of your child’s strengths, abilities, or special interests? *

Is there anything else you would like us to know?

I authorize the use of My child’s photograph for school publicity purposes. I hereby fully release and discharge Montessori Canyon Academy from any and all liability arising out of or connection with the use of my child’s photograph and all liability associated with any claim related to such use of my child’s photograph. For the purpose of this release, “liability” means all claims damages, losses, causes of action, suits or judgments of any and every kind that arise as a result of the above described activity and resulting from any other than Montessori Country Academy’s gross negligence. ! decline the use of my child’s photograph for school publicity purposes. *

A conviction may not necessarily disqualify your child from enrollment at Montessori Country Academy. Convictions include diversionary offenses, or other offenses that have been plea bargained, or for which have pleaded no contest. FAILURE TO REVEAL CONVICTIONS IS GROUNDS FOR IMMEDIATE TERMINATION OF YOUR CHILD’S ENROLLMENT.

Has either parent been convicted of a felony or misdemeanor? If the answer is YES, please explain: *

I do hereby attest that the information above is accurate and complete to the best of my knowledge and ability.

Father / Guardian Signature *

Mother / Guardian Signature *

Three + 2 = * Help Text

Montessori Canyon Academy

Montessori schooling in Alpine, UT

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Admissions

Application for Admission