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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.
The following information is submitted as part of this application:
Child’s date of birth M/ _______ D/ _______Y/ _______ Sex M _____ F _____

Home Address___________________________________ Telephone # (____) _____________________________

Father’s name ___________________ Address if different from student _________________________________


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 _____________________



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
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 _________

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