Island Children’s Montessori School Date rec’d:_________
9723 Coppertop Loop #203 Check #:__________
Bainbridge Island WA 98110 Dep. Rec’d:________
206-842-8770
Application for Enrollment
Child’s Name__________________________________________________________
Date of Birth: ____________________________ Age in Sept.__________________
Mother’s Name: _____________________ Father’s Name___________________
Address: _______________________________________________________________
Alternate address: _____________________________________________________
Phone Numbers: (Home) _______________________________________________
Work (Mother) ____________________ (Father) ____________________________
Cell (Mother)______________________ (Father)___________________________
Preferred daytime contact: ____________________________________________
Preferred email address:________________________________________________
Mother’s employer: ____________________________________________________
Father’s employer: _____________________________________________________
What are some of your child’s favorite activities? ________________________ ________________________________________________________________________What are your expectations for your child’s experience at ICMS? ________ ________________________________________________________________________
Do you have areas of concern (speech, motor skills, etc)? _______________ ______________________________________________________________________
Does your child have any allergies, health issues or physical disabilities that might affect his/her school experience? ________________________________
_______________________________________________________________________
Please indicate your preferred schedule:
AM (8:30-11:30) MON-TUES-WEDS- THURS
(AM Schedule is a three OR four day program)
PM (12:00-3:30)
MONDAY-THURSDAY
(PM Schedule is a four day program)
Lunch Option: Mon Tues Wed Thurs
1. $75 Non-refundable registration fee. Attached to application.
2. Non refundable deposit of 10% of total annual tuition. This will be applied to the June tuition. Due upon acceptance. Both of these deposits are Non-refundable
Island Children’s Montessori School is a non-profit organization. ICMS does not discriminate on the basis or race, color, national or ethnic origin in its educational, admission and scholarship policies and programs.
