Application for Admission
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 Lor-Jon Montessori School
367 Spring Rd. Elmhurst, Illinois 60126 (630) 993-0109 2013/14 Application for Admission I, __________________________, hereby make an application for admission of ____________________________ as a pupil at the Lor-Jon Montessori School for the academic term beginning September 2013 or (M/Y) _________ and ending June 2014.
Home Address___________________________________ Telephone # (____) _____________________________ ___________________________________
_________________________________ Occupation_______________________ Name and address of employer _________________________________ Work phone # (____) __________________ _________________________________ Cell phone # (____) __________________ _________________________________ E-Mail address_____________________________________Religion _____________Nationality ______________ Mother’s name ___________________Address if different from student _________________________________ _________________________________ Occupation______________________ Name and address of employer _________________________________ Work phone # (____) __________________ _________________________________ Cell phone # (____) __________________ _________________________________ E-Mail address_____________________________________Religion _____________Nationality ______________ Child’s physician____________________________________ Telephone (____) ____________________________ Address ______________________________________________________________________________________ Does your child have any allergies ? Y/N If yes, please specify__________________________________________ Persons to be called in case of emergency if a parent cannot be reached? _________________________________ Home # (____) __________________ Cell # (____) _________________ _________________________________ Home # (____) __________________ Cell # (____) _________________ If neither parent can be contacted, I authorize the school administration to take such emergency action as deemed necessary. Names of people, other than parents who are authorized to pick up my child from school: _________________________________ Home # (____) __________________ Cell # (____) _________________ _________________________________ Home # (____) __________________ Cell # (____) _________________ _________________________________ Home # (____) __________________ Cell # (____) _________________ Names and ages of siblings _______________________________________________________________________ Has your child attended a pre-school or kindergarten before? Y/N Where? _______________________________ I authorize the school to allow my child to be taken outside for supervised outdoor activities. Parents Signature ____________________________________________________ Date _____________________ ____________________________________________________ (OVER)
I/we understand that children are admitted for the full academic year and that I/ we are responsible for the tuition for the full 2013-2014 academic year, or that portion of the academic year following my child’s date of withdrawal. I/we are also responsible for full monthly payments even if days are missed due to school vacations, personal vacations, illness, or dismissal from school for any cause after the date of admission. Tuition and Fees for the 2013-2014 Academic Year: Registration fee: $75.00 per student. Please note that this fee is non-refundable. Monthly Tuition: 3-6 Year-Old Classes Toddler Classes 3 Days a week 4Days a week 5 Days a week 2Days a week 3 Days a week 4 Days a week $420.00 $445.00 $470.00 $410.00 $435.00 $460.00 Early Drop-Off (Beginning at 8:00 A.M.) is an extra $25 per month per day. i.e. your child comes 5 days a week and is dropped off early on M & F. Tuition is $520.00 ( $470.00 + $50.00 = $520.00) Tuition is paid in nine equal payments, September-May. The registration fee and the first month’s tuition are to be paid before the first day of school. Please note that the registration fee is separate from tuition and cannot be deducted from the first month’s tuition. Monthly tuition payments are due on the first of the Month or on the first day of the month that your child attends. A $20.00 late fee for all payments received after the 10th of the month. The monthly tuition may be adjusted for a child starting in the middle of the month. I/we understand that I may withdraw this application providing I give written notice to the administration of Lor-Jon Montessori School thirty days prior to my child’s scheduled entry. I/we understand that the $75.00 registration fee is non-refundable. Each family will receive a school calendar and a Lor-Jon Montessori Handbook. By signing this application, you affirm that you will abide by the guidelines set forth in the handbook. I/we grant permission for the use of photographs or digital images in which my child may appear to be used for educational and public relations purposes, such as articles in the paper, slides, films, or the school website www.lor-jonmontessori.com. Health Forms : All new students MUST have a current health form on file prior to the start of school. Please inform us of any allergies your child may have on the front page of this form and in the parental questionnaire. All Kindergarten children MUST provide an updated health form AND proof of a dental exam. I/we agree in consideration of the acceptance of my child as a student of Lor-Jon Montessori School, to indemnify the school, administration, and staff against any claims and demands made by or on behalf of my child ______________________________________________. ___________________________________ ______________ Please Check ______ Toddler Class (AM only) Signature of parent or guardian Date ______ Morning 3-6 Class ___________________________________ ______________ ______ Afternoon 3-6 Class Signature of parent or guardian Date Please indicate the days of the week you would like your child to attend. M T W Th F Early Drop-Off- M T W Th F Note : 2 days a week is only available to toddlers. All 3-6 year-old children must attend either a Monday or a Friday Application received ____________ Registration Received _____________ Check # ________ Amount _________ |