Student Personal Information
Student First Name
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Student Last Name
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Gender
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Select an option...
Male
Female
Date of Birth
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Grade Applying For
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Select an option...
Primary Level - must be 4.9 as of Sep 1, and fully toilet trained
Lower Elementary - must be 6 by Dec 31, and successfully completed KG
Primary Language Spoken at Home
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Secondary Language Spoken at Home
Home Address (number and street name)
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City and State
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Zip Code
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Parent/Guardian 1 Information
Parent/Guardian 1 Full Name
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Parent/Guardian 1 Email
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Parent/Guardian 1 Phone
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Parent/Guardian 1 Relationship to Student
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Parent/Guardian 1 Occupation
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Parent/Guardian 1 Employer
Parent/Guardian 1 Proof of Identification
*
Parent/Guardian 2 Information
Parent/Guardian 2 Full Name
Parent/Guardian 2 Email
Parent/Guardian 2 Phone
Parent/Guardian 2 Relationship to Student
Parent/Guardian 2 Occupation
Parent/Guardian 2 Employer
Parent/Guardian 2 Proof of Identification
Emergency Contacts
Emergency Contact 1 Full Name
*
Emergency Contact 1 Phone
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Emergency Contact 1 Relationship to Student
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Authorized for Pickup
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Select an option...
Yes
No
Emergency Contact 2 Full Name
*
Emergency Contact 2 Phone
*
Emergency Contact 2 Relationship to Student
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Authorized for Pickup
*
Select an option...
Yes
No
Other Authorized Pickup Personnel
List all Other Authorized Pickup Personnel
Medical & Health
Upload a Copy of the Student Vaccination Record
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Does the student have any known allergies?
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Yes
No
Please list all known allergies and severity level:
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Does the student have any chronic medical condition(s)?
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Yes
No
Please list and describe the student's chronic medical condition(s):
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Does the student require medication or treatment during school hours?
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Select an option...
Yes
No
Please describe the medication, treatment, and any instructions:
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Does the student have any special needs, learning differences, developmental needs, or disabilities that the school should be aware of to best support their learning and well-being?
Select an option...
Yes
No
Please describe the student's needs and any accommodations or support that have been helpful:
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Does the student currently have an Individualized Education Program (IEP), Individualized Family Service Plan (IFSP), or Section 504 Plan?
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Select an option...
Yes
No
If yes, please upload a copy of the most recent plan (if applicable).
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Health Insurance Provider
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Physician Name
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Physician Phone
*
Do you authorize Oak & Olive Montessori to obtain emergency medical treatment if necessary?
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Select an option...
Yes
No
Anything else we should know regarding your child's health?
Academic History
Previous School Name
City and State
Last Grade Completed
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None
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
Financial Information
Tuition Payment Plan
*
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Full Year (10 months)
Monthly
Additional Comments
Additional Comments
Consents & Agreements
Electronic Signature
*
I confirm that all information provided is accurate and complete.
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