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APPLICATION FORM

INSTRUCTIONS: Please fill out this form, and mail with a check for $100 payable to

“Topanga Montessori School” to: Director of Admissions

The Topanga Montessori School 1459 Old Topanga Canyon Rd. Topanga,

CA 90290

Child’s Full Name ____________________________________________________

Last Middle First

Preferred Name of Nickname:

Age___________ Date of Birth ________________ Country of Birth

Month/Day/Year

Citizen of______________________

Current School: ___________________________ Address___________________________

Previous School:1)___________________________ Address_________________________

Language(s) spoken at home:________________________________

Family Information

Parent Parent

Name	Name
Address	Address
City _____________Zip_______	City _____________Zip_______
Home Phone ( )	Home Phone ( )
Home Fax ( )	Home Fax ( )
Home email	Home email
Employer	Employer
Address	Address
Phone	Phone

If parents are separated or divorced with whom does the child live?

Who is or are the legal guardians of the child?____________________________________

Address and Phone numbers of legal guardian(s)___________________________________

To whom should correspondence be addressed?____________________________________

Name the Stepparents(s) in child’s home(s): ________________________________________

Please list the names and ages of sister(s) and brother(s) and the schools they attend.

Any other adults living in the home? __________________________________________________

Other Information:

Upon enrollment, may we share your name/address/phone number with other enrolled families in a school directory?

Yes _________ No__________________

To which other schools have you made applications?_______________________

Who referred you to the Topanga Montessori School?_______________________

Signatures:

Signatures of Parent or Guardian _________________________________________________

Relationship to applicant ___________________________ Date ________________________

Please feel free to call the Admissions Office, if you have any questions:

Statement of Policy

The Topanga Montessori School is open for applicants regardless of cultural heritage, race, nation of origin, gender or sexual orientation, who demonstrates appropriate academic qualifications, character and purpose.