Application Form Lakewood Montessori Christian School - Application FormPart A: Student InformationStudent Name* First Last Home Address* Street Address City State / Province / Region ZIP / Postal Code Home Phone #*Birth Date (MM/DD/YYYY)* Date Format: MM slash DD slash YYYY ReligionDoctor*Address*Phone#*Special Needs (important information regarding your child):Part B: Parent InformationParent 1 Name* First Last Home Address* Same as child's home address Street Address City State / Province / Region ZIP / Postal Code Employer*Employer Address*Home #*Cell#*Work#*Work# extParent Email Parent 2 Name First Last Home Address Same as child's home address Street Address City State / Province / Region ZIP / Postal Code EmployerEmployer AddressHome #Cell#Work#Work# extParent Email Part C: Emergency Contact (List in order, names of persons to be called in an emergency situation, excluding parents) Emergency Contact#1 Name* First Last Address*EmployerEmployer AddressHome #*Cell#*Work#*Work# extEmail* Emergency Contact#2 Name* First Last Address*EmployerEmployer AddressHome #*Cell#*Work#*Work# extEmail* Part D: Release Information (names of persons to whom the child may be released)Name*Relationship*Contact#*NameRelationshipContact#NameRelationshipContact#Check the box beside the statement:* I will contact the School Office immediately if any of the above information changes. I certify that all this information is correct.Signature*Non-refundable initial fee Price: $1,000.00 Date Date Format: MM slash DD slash YYYY Once you submit the application, please pay $1000 non-refundable initial fee. The initial fee can be E-transfered to carmenshave@gmail.com with the designated password LAKEWOOD
