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Early Childhood Education by the Montessori Method since 1978
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Enrollment Application
Enrollment Application
wpsupport@cornerpxl.com
2025-09-22T20:10:42+00:00
Application
Child's Name
First
Last
Birth Date
(Required)
MM slash DD slash YYYY
Age
Sex
Male
Female
Home Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Parent/Guardian 1
Parent/Guardian 1's Name
First
Last
Employer
Email
Mobile Phone
(Required)
Work Phone
Home Phone
Parent/Guardian 2
Parent/Guardian 2's Name
First
Last
Employer
Email
Mobile Phone
(Required)
Work Phone
Home Phone
Program
Select a Program
(Required)
Make a Selection
Toddlers - 16 months to 24 months
Stepping Stones - 2 to 3 years
Primary 1 - 3 to 5 years
Primary 2 - 4.5 to 6 years
Schedule
(Required)
Morning Only: 9am to 12pm
Full Day: 9am to 2:30pm
Morning Only
Full Day
Days
(Required)
Select Number of Days
Check your preferred days
(Required)
Monday
Tuesday
Wednesday
Thursday
Friday
Extended Day
(Required)
7:30am to 5:45pm
Yes
No
More Information
Does your child have any siblings?
Yes
No
Sibling Information
What would you like us to know about your child?
e.g. Temperament, learning style, socialization style
Language spoken at home
Status of parents
Married
Separated
Divorced
Single
What are the visitation arrangements for your child?
Court Document
Attach a copy of the court document concerning visitation arrangements.
Max. file size: 50 MB.
If there has been a custody decision, please list the name(s) of persons NOT PERMITTED to pick up your child from school.
Please list below, in preferential order, anyone other than yourself who has authorization to pick up your child.
These individuals will be contacted in an urgent situation including medical or weather emergency, in the event that neither parent can be reached.
Previous childcare experience:
Healthcare Provider
Phone
Application Fee
A non-refundable deposit of $250.00 is due at the time the application is submitted.
How would you like to process payment for deposit?
(Required)
Check
Venmo
Zelle
Application Fee
Total
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