MONTESSORI ENRICHMENT CENTER
29 Newbury Road
Howell NJ 07731
(732) 364-2244
Fax (732)363-4371

For Office Use Only:

Date Application Rec'd:  
Fee Paid Amount: Ck#_______
Session R ET3 ET2 LT3 LT2 F K
REGISTRATION FORM
Please check the sessions desired by indicating order of preference- #1, #2, etc.
Check Under Here
Morning Session 9:00 am-11:30 am Mon- Fri  
Afternoon Session 12:30 pm-3:00 pm Mon- Fri  
Full Day Session 9:00 am- 3:00 pm Mon- Fri  
Kindergarten Program (5 year olds) 11:30 am- 3:00 pm Mon- Fri*  
(* Must also include a morning session)
Three Day Transitional Session 12:30pm-3:00pm Mon, Wed, Fri  
Three Day Early Morning Tot Program 8:45- 10:15 am Mon, Wed, Fri  
Two Day Early Morning Tot Program 8:45- 10:15 am Tues/Th  
Three Day Late Morning Tot Program 10:30 am- 12:00 pm Mon, Wed, Fri  
Two Day Late Morning Tot Program 10:30am- 12:00 pm Tues/Th  
Two Day Afternoon Tot Program 1:30pm-3:00pm Tues/Th  
Full Day Toddler Session 8:45am- 3:00pm
- 2 Day Tues/Th 		 
- 3 Day Mon,Wed,Fri  
- 5 Day Mon- Fri  
After School Care 3:00 pm-5:30 pm Mon-Fri  
Early School Care 8:00 am- 9:00 am Mon-Fri  
PLEASE PRINT
Child's Name: ________________________________________ _____________________________________
(last name) (first name)
Nick Name: ________________________________________
Sex: __________  
Address: ________________________________________ City: _________________________
________________________________________ Zip code: _________________________
Phone #: ________________________________________ Date of Birth: _________________________
    Age (as of 9/1): _______________
Father's Name: ________________________________________ Occupation: _________________________
Business Name:
 ________________________________________
Business Address: ________________________________________  
________________________________________  
Business Phone : ________________________________________ Cell Phone: _________________________
Mother's Name: ________________________________________ Occupation: _________________________
Business Name:
 ________________________________________
Business Address: ________________________________________  
________________________________________  
Business Phone : ________________________________________ Cell Phone: _________________________
Emergency Contact Name: ________________________________________ Phone: ___________________
Address:
 ________________________________________
________________________________________  
________________________________________  
Physician's Name: ________________________________________ Phone: ___________________
Address:
 ________________________________________
________________________________________  
________________________________________  
Name(s)/ages of other child(ren): ___________________________ _________________________

___________________________ _________________________
___________________________ _________________________
Previous Group Experience: _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Pertinent Medical Information (allergies, meds, etc.): _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Comments which would help us meet your child's individual needs/Favorite activities/toilet trained/your hobbies and interests*: _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Signature: _______________________________________________ Date: _______________
A $25.00 application fee is required and not refundable
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