Student's Information

First Name *

Middle Name

Last Name *

Preferred Name

Present Grade

Grade applying for *

Grade applying for

I am interested in Before and After School care (7:00 a.m. - 6:00 p.m.)

Yes

No

Maybe

Date of birth *

Age

Current or most recent school

Gender *

Male

Female

Self-identify:

Grades attended

Have any behavioral, educational, or psychological evaluations been performed on your child?

Yes

No

How do you think your child will benefit from an education at White Rock Montessori School?

Please describe your child’s interests, temperament, challenges :

During the past 12 months, has your child experienced any health problems, social or emotional problems, or significant changes in the family? Please explain.

Student is living with

Father

Mother

Stepfather

Stepmother

Legal Guardian

Grandmother

Grandfather

Other

Relationship to Student *

Name of student's current or most recent school (if applicable)

Please describe your child's special abilities, interests, temperament, challenges.

Please describe any physical limitations which may affect your child's health, school work, or participation in physical activities.

Name

First

Last

Address *

City

State

ZIP Code

Email

Cell Number *

Relationship to Student

Name

First

Last

Address

State

ZIP Code

Email *

Cell Phone *

Name

First

Last

Birthdate

School

Please list any relatives who are attending or who have attended White Rock Montessori.

Please let us know how you learned about White Rock Montessori:

Google Search

Website

Current White Rock Montessori family

Alumni White Rock Montessori family

Advertisement in White Rock Weekly newspaper

Advertisement in Advocate Lakewood/East Dallas magazine

Advertisement in Advocate Lake Highlands magazine

Advertisement in DFWChild magazine

Facebook

Instagram

LinkedIn

Other

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