Rockland Montessori Academy
For Young Learners

Registration for the 2011-2012 School Year
Infants and Toddlers  (age 3 months to 2 years and nine months)

Child's Name_________________________________________________________


Date of Birth___________________      Boy______        Girl______


Address_____________________________________City____________Zip______


Home Phone______________________Cell Phone___________________________

Please circle the days and times you wish for your child:

Part time Program:                                           
Morning Session (8:30am to 1pm)    M  T   W  Th  F 

Afternoon Session (1pm to 5:30pm)       M  T   W  Th  F 

Full Days:                                           
Full-Day Program (8:30 am to 5:30 pm)    M  T   W  Th  F 
                
Extended Day:                                           
        Early Drop off  (7:30 am to 8:30 am)  M  T   W  Th  F 
                                                                        
        

**Please include the non-refundable $100 registration fee.**