PLEASE BE ADVISED THAT NO ENROLLMENT FORMS FOR THE 2008-09 SCHOOL YEAR WILL BE
ACCEPTED BEFORE JANUARY 13TH.  IF YOU WISH TO SEND YOUR FORM IN PLEASE MAKE
SURE IT DOES NOT ARRIVE BEFORE THE 13TH.  ALL THOSE ARRIVING
BEFORE THAT DATE WILL BE ADDED TO OUR LIST AFTER FORMS LEFT AT OUR OPEN HOUSE
OR ARRIVING TO THE SCHOOL ON JANUARY 13TH. YOU ARE ALSO WELCOME TO DROP YOUR FORMS OFF ON MONDAY
MORNING THE 14TH BEGINNING AT 7:00 A.M.





Date:  _________________




                                                                                      
                           MIDLAND MONTESSORI SCHOOL
                                 2008 - 2009                                                           

                      Registration Fees:  $175 for all programs

                       All registration fees are non-refundable                
                               Sorry, No Exceptions



Child's Name:  _____________________________  Nick Name: ____________


Date of Birth:  ___________  Male/Female      Program:  _____________________  

Home Address:  _________________________________ Zip:  ____________

Home Phone:  _____________________  E-Mail Address:  ________________ 

Father's Name:  ______________________  Social Security Number:  _____________

Home Address (if different): ___________________________________________

Work Phone:  _________________________     Cell Phone:  _____________________

Occupation: _____________________     Place of Employment: ___________________

   Are you willing to be contacted for occupation associated advice?  ____ Yes  ____ No

Mother's Name:  _______________________  Social Security Number: ____________

Work Phone:  _________________________    Cell Phone:  _____________________

Occupation: _____________________     Place of Employment: ___________________

   Are you willing to be contacted for occupation associated advice?  ____ Yes  ____ No

Referred By:  ________________________________