Summer Program

Medina Montessori
Summer Program 2019 Registration Form
June 17th - July 20th and July 23 - August 16th
Children Ages 3-7

* Indicates required field

STUDENT NAME *

First

Last

GENDER *

MALE FEMALE

Languages Spoken at Home *

AGE *

ADDRESS *

Line 1

Line 2

City

State

Zip Code

Country

BIRTH DATE *

Home Phone *

Name of any other school/program student attended: *

Select Sessions or Weeks *

Session 1 : June 17 - July 20 Session 2: July 23 - August 16

Select Your Schedule (Mon-Fri) *

Primary Half Day - 8:30AM-12:00PM - $850/session Standard Day - 8:30AM - 2:15PM - $1220/session Full Day - 8:30AM - 5:00PM - $1430/session

Father's Name *

First

Last

Mother's Name *

First

Last

Father's Phone *

Mother's Phone *

Father's Email *

Mother's Email *

Submit