Name of Child *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Child's Gender *

Male

Female

Name *

First Name

Last Name

Phone Number *

(###)

###

####

Name

First Name

Last Name

Phone Number

(###)

###

####

Primary Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Home Phone *

(###)

###

####

Caregiver *

Please indicate whether a caregiver, sitter, or nanny works with your child during the day

Yes

No

Caregiver's Name

First Name

Last Name

Parent/Guardian Union

What is the marital status of the primary parents/guardians?

Single

Married

Separated

Divorced

Other

Child's Legal Guardian *

First Name

Last Name

REQUIRED Child Health Examination Form (see PDF below) *

HAVE YOU FILLED OUT AND RETURNED THE PDF BELOW? via email: enroll@elitemindsmontessori.com or mail: Elite Minds Montessori, 117 Union Street, Brooklyn, NY 11231

YES

NO

Programs *

Please select the program(s) you wish to enroll your child in. Part week is only available to infant/toddlers (9 - 23 months).

5 Day Half Day Program 8:30am - 11:30am

5 Day Full Day Program 8:30am - 2:30pm

5 Day Full Day Program/Extended 8:30am - 5:00pm

Early morning drop off 7:45am

Extended Day (until 6pm)

3 Day Program 8:30am - 11:30am (Monday/Wednesday/Friday)

3 Day Program 8:30am - 2:30pm (Monday/Wednesday/Friday)

3 Day Program 8:30am - 5:00pm (Monday/Wednesday/Friday)

2 Day Program 8:30am - 11:30am (Tuesday/Thursday)

2 Day Program 8:30am - 2:30pm (Tuesday/Thursday)

2 Day Program 8:30am - 500pm (Tuesday/Thursday)