STUDENT INFORMATION Student Gender MaleFemale Is English the student's first language? YESNO COURSE SELECTION Preferred Montessori Class (3 to 6 years old) Leefield location: AMLeefield location: PMLeefield location: Full DayMeyonohk location: AMMeyonohk location: PMEllwood location: Full DayEllwood location: Extended KPM (busing to Ellwood required) Preferred Out-Of-School Care (OSC) - Grade 1 to 6 Meyonohk location: Before & After SchoolMeyonohk location: After School OnlyLeefield/Ellwood locations: After School Only (busing is required) FIRST PARENT/GUARDIAN INFORMATION Does the student reside with this individualYESNO SECOND PARENT/GUARDIAN INFORMATION Does the student reside with this individualYESNO EMERGENCY INFORMATION (other than the student's parent or guardian) EMERGENCY CONTACT 1 EMERGENCY CONTACT 2 STUDENT'S MEDICAL HISTORY Immunization up-to-date YESNO ADDITIONAL INFORMATION Submit ******************************************************* Δ