Westside Montessori

Online Application

	Email Address
	Date you wish your child to commence school?
	Class preference:
	Would you consider taking a space in any available class ?
	Name of child
	Name child is called at home:
	Address:
	Postal code:
	Home Phone #:
	Sex:
	Date of Birth
	First language
	Other languages spoken
	Parent / Guardian information :
	Female:
	Name
	Place of work
	Daytime phone #	E xt:
	Address:
	Male:
	Name
	Place of work
	Daytime phone #	E xt:
	Address:
	Alternative person to call in case of emergency:
	Name
	Relationship
	Phone #	E xt:
	Family Doctor:
	Name
	Phone #	E xt:
	Family Dentist
	Name
	Phone #	E xt:
	Personal Health Number
	Siblings
	Name
	Birthdate
	Name
	Birthdate
	Name
	Birthdate
	What activities does your child like to do?
	Alone
	With others
	Are playmates available?
	Has your child had previous experience away from home (Daycare, Nursery School, Preschool, Kindergarten, etc.)?
	If yes:
	Where
	Dates attended
	Were there any special problems?
	is your child currently attending another school oor program?
	If Yes, please explain why your child left previous school/program or why you wish your child to leave:
	Why do you wish your child to attend Westside Montessori School?
	If you child has any health problems, illnesses, or operations, please indicate what they are (please provide dates):
	Does your child have any (please provide details):
	Special medications?
	Allergies?
	Vision/hearing difficulties?
	Food dislikes?
	Special diets?
	Special eating habits?
	Comments on the above (you will be required to complete a certification of immunization status form):