1Student Information2Parent Information3Other Info Student Name* Student - First Name Student - Last Name Date of Birth or Due Date* MM slash DD slash YYYY Child's Sibling Name (If currently at PLMS) Requested Start Date MM slash DD slash YYYY Date of School Tour* MM slash DD slash YYYY Requested Entry Age of Student1234567891011121314151617 Mother/Legal Guardian Name* Frist Name Last Name Mother/Legal Guardian Email* Mother/Guardian Business Phone NumberMother/Guardian Cell Phone Number*Mother/Guardian Home Phone Number*Father/Legal Guardian* First Last Father/Legal Guardian Email Father/Guardian Business Phone NumberFather/Guardian Cell Phone NumberFather/Guardian Home Phone Number Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code What, in particular, attracts you to choose Pine Lake Montessori school for your child's education?* How did you hear about Pine Lake Montessori School? Advertising: Our Kids Advertising: Google Ads Advertising: Yellow Pages CCMA Website Newspaper or Magazine Referral by a friend or a family Mother/Legal Guardian Name First Father/Legal Guardian Name First As a parent/guardian of the child, does your work allow you to work remotely? (Parents who do not have option of working remotely will have priority over other families in getting a spot at PLMS)Mother* Yes No Father* Yes No Receive emails from Pine Lake Montessori School? I & my partner would like to receive emails from Pine Lake Montessori School NameThis field is for validation purposes and should be left unchanged.