Registration Form

Johnson County Montessori Preschool was established in 1965 to encourage young children’s natural love for learning and developing problem-solving skills they will use in the classroom and everyday life. Our Montessori-trained and certified teachers provide individualized lessons using proven teaching methods. We offer an integration program for children with special needs.

Question Title

* 1. Child's Name

Question Title

* 2. Child's Gender

Question Title

* 3. Child's Date of Birth

Question Title

* 4. Parent 1 Name, Address & Contact Number

Question Title

* 5. Parent 2 Name, Address & Contact Number

Question Title

* 6. Child's Primary Home Address

Question Title

* 7. Child's Primary Home Phone Number

Question Title

* 8. Emergency Contact Number

Question Title

* 9. E-mail Address

Question Title

* 10. Child's Physician Name

Question Title

* 11. Child's Physician Address

Question Title

* 12. Child's Physician Phone Number

Question Title

* 13. Child's Dentist Name

Question Title

* 14. Child's Dentist Address

Question Title

* 15. Child's Dentist Phone Number

Question Title

* 16. Persons to Contact in Emergency/Illness Situation (other than parent/legal guardian). Please include phone number for each contact.

Question Title

* 17. Are the emergency contacts listed allowed to pick up your child?

Question Title

* 18. Name and age(s) of siblings

Question Title

* 19. Does your child have any physician diagnosed medical conditions?

Question Title

* 20. Does your child have any diagnosed allergies?

Question Title

* 21. Does your child have any diagnosed intellectual and/or developmental disability?

Question Title

* 22. Does your child have any prescribed dietary restrictions? 

Question Title

* 23. What program are you interested in enrolling your child in? 

Question Title

* 24. Select 1 program option for your child

Question Title

* 25. How did you find out about CLO's Montessori Preschool & Kindergarten?

Question Title

* 26. STATEMENT OF UNDERSTANDING*I certify that the information I provided on and in connection with this form is true, accurate, and complete. I also understand that if I make any false statement or deliberate omissions on and in connection with this form, CLO reserves the right to refuse to serve the applicant, terminate the application process, remove the applicant from the waiting list, and/or terminate services.I have read and understand this statement.

Question Title

* 27. STATEMENT OF UNDERSTANDING: I understand that a nonrefundable $75 registration fee must accompany this registration before my child will be considered enrolled. When my child is ill, I understand that s/he may not be accepted into care. I also understand that the CLO Johnson County Montessori Preschool, Day Care and Kindergarten and/or its employees will not be held responsible if items my child brings onto the premises are lost, stolen, or damaged. I agree to read and comply with other policies of CLO Johnson County Montessori Preschool, Day Care and Kindergarten that may be communicated to me via parent bulletins, letters, handbooks, or by other means. I hereby give CLO permission to utilize photographic images of my child in a responsible and professional manner in advertising or promotional materials, for fund-raising or developmental purposes, and for general public information purposes. Specifically, I give my permission for photographic/videotape/digital images to be utilized in the CLO website and/or other selected publications or promotional materials.   

T