Please complete this form by Copy and Pasting it into an email or word document and sending it to us at info@montessorieco.nz

REGISTRATION OF INTEREST

Child’s Name: _______________________________Date of birth: _______
Sex: Male/Female   Ethnic Group: _________________
First Language: ­­­­­­­­­_____________________

Parents:
Mother’s Name: _________________________________________________
Address: _________________________________________________________
Email: ____________________________________________________________
Phone: ___________________________________________________________
Occupation: ______________________________________________________

Father’s Name: __________________________________________________
Address: _________________________________________________________
Email: ____________________________________________________________
Phone: ___________________________________________________________
Occupation: _____________________________________________________

Are there any special circumstances regarding the child’s health or situation? (This is helpful for curriculum planning and obtaining any special needs assistance.) ___________________________________________________________________________
[ ] I apply for the above child to be registered as a prospective pupil at South Wellington Montessori School. I understand that this does not automatically guarantee my child a place in the school.

Signature: ________________­­­­­­________________(Parent) Date: ____________

Signature: ________________________________(Parent) Date: ____________