Application for Enrollment Please use the following application form to submit your application for enrollment. Alternatively, you can download a PDF copy of our enrollment application here. 1 Contact Information2 Emergency Contact/Student Release Information3 Additional Information Student InformationStudent Name* First Last Home Phone*Address* Street Address City Postal Code Date of Birth* Date Format: MM slash DD slash YYYY Medical InformationDoctor/Physician* First Last Address* Street Address City Postal Code Phone Number*Medical History*Please list any serious allergies or medical conditions and/or medication our child takes regularly.Parent/Guardian InformationFather's Name* First Last Father's Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone*Business Phone*Cell Phone*Email Address* Business Phone*Employer Name and Address*Mother's Name* First Last Mother's Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone*Business Phone*Cell Phone*Email Address* Employer Name and Address* Emergency Contact/Student Release Information Please list the names and numbers for individuals other then yourself that may be contacted in the event of an emergency or may pick up your child in your absence.Full Name* First Last Address* Street Address City Postal Code Phone #1*Phone #2*Full Name* First Last Address* Street Address City Postal Code Phone #1*Phone #2*Full Name* First Last Address* Street Address City Postal Code Phone #1*Phone #2*The information that has been provided to the school is correct and accurate. Any of the above information will be updated to the office immediately should there be any changes. I/We verify that the information above is correct.* Father's Verification Mother's Verification Additional InformationProgram Requested*Toddler (18 months - 2 ½ years)Casa (2 ½ - 6 years)Please checkmark beside the requested program* Full Day with extended hours (7:30am-6:00pm) School Day only (8:45am-3:30pm) Days Requested* Monday Tuesday Wednesday Thursday Friday Address for Correspondence Please indicate where the following information may be sent to:Tax Receipts or billing, same as attached orEmail address for school correspondenceCustody ArrangementsPlease indicate custody arrangements if separated or divorced and with whom information or correspondence should be provided to.*Medical Release*In the case of an accident or illness of my child while in attendance at Young Minds Montessori, I agree to allow the staff of Young Minds to obtain the necessary medical attention, including anesthetic and or prescribed medication if necessary, by a practicing physician. Father's Verification Mother's Verification Δ
