Student

Surname

Given Names (begin with name used)

Address: Street

City

Postal Code

Telephone

Birthdate ( D/M/Y)

Present Age

Emergency Names and Numbers

Child's OHIP Number

Please list ant allergies

Please list any communicable diseases your child has been exposed to (chicken pox, measles, mumps, etc.)

We, the undersigned, individually and severally, agree that if the applicant is accepted for admission to Manor Montessori School Inc.., we will and/or understand:

1. Comply with all rules and regulations of the school
2. Pay all fees and extras in respect to the student, as and when due
3. Fully understand that when the child is accepted into the program that the $1000. / $1,500. fee is non-refundable and non-transferable under any circumstances
4. All children attending Manor Montessori School must be fully toilet-trained

Date

Parent or Guardian's Signature

OFFICE USE ONLY

Date letter of acceptance sent:
Date of admission:
Date of discharge:

Surname

Given Names (begin with name used)

Address: Street

City

Postal Code

Telephone

Business name

Email address

Surname

Given Names (begin with name used)

Address: Street

City

Postal Code

Telephone

Business Name

Email Address