Student Application - Clover Sites
Student Application 1423 Julia Street Fernandina Beach, FL 32034 904.261.6610 ameliaislandmontessori.com
Applying for school year: Fall Spring 20__-20__ Toddler Morning Only 9.00 am – 12.00 pm Toddler Full Day 9.00 am – 3.00 pm Primary Morning Only 9.00 am – 12.00 pm Primary Full Day 9.00 am – 3.00 pm Middle School
VPK Kindergarten Lower Elementary Upper Elementary
Will you be needing before-school (7:30 am – 9.00 am) or after-school (3.00pm – 6.00pm) care? Yes: Before
No: Before
Yes: After No: After
CHILD’S INFORMATION _______________________________ ______________________________________ ______________________________ Child’s Last Name First Name Middle Name ______________________________________ Preferred Name
_________ Sex
_________________________________________________ Date of Birth
_________________________________________________ Home Phone
_________________________________________________ Cell phone
_________________________________________________ 1st Parent’s Email
_________________________________________________ 2nd Parent’s Email
_________________________________________________ Street Address
_________________________________________________
__________________________________________________ City _________________________________________________ Name of Current/Previous School
_____________ State
_________________________ Zip code
_________________________________________________ Dates attended
_______________________________________________________________ Previous School Address Is the applicant related to alumni of Amelia Island Montessori School?
______________________________ Phone Number Yes
No
1st PARENT’S/GUARDIAN’S INFORMATION _______________________________ ______________________________________ ______________________________ Last Name First Name Relationship to applicant _________________________________________ Address Check here if the same as applicant
____________________ _____________ City State
______________________________________________________________ Employer
______________________ Zip code
______________________________________ Business Phone OVER
2nd PARENT’S/GUARDIAN’S INFORMATION _______________________________ Last Name
______________________________________ ____________________________ First Name Relationship to applicant
_________________________________________ Address Check here if the same as applicant
____________________ _____________ City State
______________________________________________________________ Employer
Applicant lives with: Check if applicable:
Both Parents
Mother
______________________ Zip code
______________________________________ Business Phone
Father
Other________________________
Parents Married Single parent Parents divorced Parents separated Student adopted
If parents are divorced or separated, who has legal custody? ___________________________________________ Who is financially responsible for the student? ______________________________________________________ ADDITIONAL INFORMATION Are there any serious health concerns of which we should be aware? If so, please explain: __________________________________________________________________________________________ Are there any learning issues of which we should be aware? If so, please explain: ____________________________________________________________________________________________ Has your child been referred / tested for any of the following? Speech and/or hearing therapy Psychological/Educational Assessment Neurological differences Visual examinations Learning differences Gifted Programs Please attach a one-time, non-refundable application fee of $50.00. Upon admissions, a one-time, non- refundable admission fee of 125.00 is due. Family Referral Program We offer a Family Referral Program for AIMS parents that refer other new families to the school. If you refer a “new” family to AIMS and they sign a one-year contract, and remain enrolled for six months, the referring family will receive a $500.00 tuition credit for the first enrollee and $1000.00 for each enrollee thereafter, up to your tuition amount. This tuition credit will be applied after the new enrollee has attended AIMS for five months. The adjustment will be made the following February or September. Non-discrimination Policy
The Amelia Island Montessori School admits students of any race, color, gender, religion or national origin to all of the rights, privileges, programs and activities generally accorded or made available to students of AIMS. We do not discriminate based on race, color, gender, religion, or national origin in administration of its educational policies, scholarships and other organization- administered programs. Volunteer Policy
We are a non-profit school that requires parent participation. Each family is expected to attend parent meetings, parent/teacher conferences, parent education workshops and to contribute at least 20 hours of volunteer time per year. _______________________________________________ ______________________________________ Parent/Guardian Signature Date How did you hear about Amelia Island Montessori School? Current/Former Parent Referring Parent Name: __________________________________________________ Website Advertisement Newspaper Other_________________________
````````````````````````````````````````````````````````````````````````````````````````````````````````````````` For Administrative Use Only: Date application received: ____________________ Received by:____________________________________ Application Fee paid: Check #_____________________ Cash Credit/Debit Card
Applying for school year: Fall Spring 20__-20__ Toddler Morning Only 9.00 am – 12.00 pm Toddler Full Day 9.00 am – 3.00 pm Primary Morning Only 9.00 am – 12.00 pm Primary Full Day 9.00 am – 3.00 pm Middle School
VPK Kindergarten Lower Elementary Upper Elementary
Will you be needing before-school (7:30 am – 9.00 am) or after-school (3.00pm – 6.00pm) care? Yes: Before
No: Before
Yes: After No: After
CHILD’S INFORMATION _______________________________ ______________________________________ ______________________________ Child’s Last Name First Name Middle Name ______________________________________ Preferred Name
_________ Sex
_________________________________________________ Date of Birth
_________________________________________________ Home Phone
_________________________________________________ Cell phone
_________________________________________________ 1st Parent’s Email
_________________________________________________ 2nd Parent’s Email
_________________________________________________ Street Address
_________________________________________________
__________________________________________________ City _________________________________________________ Name of Current/Previous School
_____________ State
_________________________ Zip code
_________________________________________________ Dates attended
_______________________________________________________________ Previous School Address Is the applicant related to alumni of Amelia Island Montessori School?
______________________________ Phone Number Yes
No
1st PARENT’S/GUARDIAN’S INFORMATION _______________________________ ______________________________________ ______________________________ Last Name First Name Relationship to applicant _________________________________________ Address Check here if the same as applicant
____________________ _____________ City State
______________________________________________________________ Employer
______________________ Zip code
______________________________________ Business Phone OVER
2nd PARENT’S/GUARDIAN’S INFORMATION _______________________________ Last Name
______________________________________ ____________________________ First Name Relationship to applicant
_________________________________________ Address Check here if the same as applicant
____________________ _____________ City State
______________________________________________________________ Employer
Applicant lives with: Check if applicable:
Both Parents
Mother
______________________ Zip code
______________________________________ Business Phone
Father
Other________________________
Parents Married Single parent Parents divorced Parents separated Student adopted
If parents are divorced or separated, who has legal custody? ___________________________________________ Who is financially responsible for the student? ______________________________________________________ ADDITIONAL INFORMATION Are there any serious health concerns of which we should be aware? If so, please explain: __________________________________________________________________________________________ Are there any learning issues of which we should be aware? If so, please explain: ____________________________________________________________________________________________ Has your child been referred / tested for any of the following? Speech and/or hearing therapy Psychological/Educational Assessment Neurological differences Visual examinations Learning differences Gifted Programs Please attach a one-time, non-refundable application fee of $50.00. Upon admissions, a one-time, non- refundable admission fee of 125.00 is due. Family Referral Program We offer a Family Referral Program for AIMS parents that refer other new families to the school. If you refer a “new” family to AIMS and they sign a one-year contract, and remain enrolled for six months, the referring family will receive a $500.00 tuition credit for the first enrollee and $1000.00 for each enrollee thereafter, up to your tuition amount. This tuition credit will be applied after the new enrollee has attended AIMS for five months. The adjustment will be made the following February or September. Non-discrimination Policy
The Amelia Island Montessori School admits students of any race, color, gender, religion or national origin to all of the rights, privileges, programs and activities generally accorded or made available to students of AIMS. We do not discriminate based on race, color, gender, religion, or national origin in administration of its educational policies, scholarships and other organization- administered programs. Volunteer Policy
We are a non-profit school that requires parent participation. Each family is expected to attend parent meetings, parent/teacher conferences, parent education workshops and to contribute at least 20 hours of volunteer time per year. _______________________________________________ ______________________________________ Parent/Guardian Signature Date How did you hear about Amelia Island Montessori School? Current/Former Parent Referring Parent Name: __________________________________________________ Website Advertisement Newspaper Other_________________________
````````````````````````````````````````````````````````````````````````````````````````````````````````````````` For Administrative Use Only: Date application received: ____________________ Received by:____________________________________ Application Fee paid: Check #_____________________ Cash Credit/Debit Card
