Admissions Application

Little Hoku Montessori Academy > Admissions > Forms > Admissions Application

1 Step 1

Student Information

Child's NameEnter Full Name

Nickname

Date of Birth

Gender

Current Address

City

State

Zip Code

Allergies and MedicationsList all allergies, dietary restrictions, special problems or diagnosis your child has. If none, just put "none".

0 /

Is your child vaccinated?Select one

Yes, received all required vaccines Partially vaccinated, planning to get the rest on a delayed schedulePartially vaccinated, not planning to get the restNo, we have a medical exemption No, we have a religious exemption

Student Childcare Experience

Has your child ever attended a daycare or preschool?

YesNo

If yes, name one of the schools.

Please provide a reference (previous teacher/school director/babysitter)

NameName of your reference

EmailEmail of your reference

PhonePhone of your reference

How did you hear about us?

Parent/Guardian 1 Information

NameEnter Full Name

Current AddressIf different from above

City

Zip Code

State

Phone NumberBest phone number to reach you

EmailA valid email

EmployerPut self-employed or unemployed if no employer.

Occupation

Do you plan to move off island in the next 2 years?

Parent/Guardian 2 Information

NameEnter Full Name

Current AddressIf different from above

State

Zip Code

Phone NumberBest phone number to reach you

EmailA valid email

EmployerPut self-employed or unemployed if no employer.

Occupation

Do you plan to move off island in the next 2 years?

Enrollment Information

Desired Start Dateof appointment

What plan are you interested in?

5 days, 8 a.m. to 4 p.m. 5 days, 8 a.m. to 12 p.m.

Signature

Parent 1 SignaturePlease sign here before submitting the admissions application

(Sign Here)

Clear Signature

Parent 2 SignaturePlease sign here before submitting the admissions application

(Sign Here)

Clear Signature

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