Admissions Application: Locust Point Location

Student Information

Male Female

First Name

Last Name

Phone

Date of Birth

Street Address

Address Line 2

City

State Zip

Medical Information

Allergies or diet restrictions?

Conditions which require standing medication orders (e.g. epi-pens, inhalers)?

How did you hear of us?

Previously attended school/center(s)

School/center(s)

Date(s) of Enrollment

Requested date of entry

Requested date of entry?

Guardian Information

Father Step-Father Guardian

First Name

Street Address

Address Line 2

City

State Zip

Home Phone

Business Phone

Occupation/Title

Employer Name

Employer Address

Employer Address Line 2

City

State Zip

Pager

Mobile Phone

Guardian Information

Mother Step-Mother Guardian

First Name

Street Address

Address Line 2

City

State Zip

Home Phone

Business Phone

Occupation/Title

Employer Name

Employer Address

Employer Address Line 2

City

State Zip

Pager

Mobile Phone

Parent's Marital Status

Married Single Separated Divorced Mother Deceased Father Deceased

If Parents are divorced or separated, who has legal custody?* *A copy of court documentation must be provided to The Baltimore Montessori for the child's file.