Reservation Request

Title

First Name

Last Name

Email Address

Mobile Number

Alternate Contact Number

Child’s First Name

Child’s Last Name

Child’s Date of Birth

Child’s sex

Mother’s name

Mather’s Mobile Number

Father’s name

Father’s Mobile Number

Home Address

Has the child had any other pre-school or crèche experience?

Details of other preschool:

Does the child understand and communicate in English? If No, please specify:

Details of languages:

Special / additional needs

Does your child suffer from any medical conditions? If so, please outline details below:

Details:

Does your child suffer from any physical disabilities? If so, please outline details below:

Details:

Does your child suffer from any hearing and/or speech difficulties? If so, please outline details below:

Details:

Does your child have any specific dietary requirements:? If so, please outline details below:

Details about diet:

Does your child have any allergies? If so, please outline details below:

Details:

Do you have any concerns or worries about your child’s development? If so, please outline details below:

Details about Development:

Other relevant information:

I wish to apply for a ECCE place for ma child in Mi Casa Montessori Pre-school. (Disclaimer: Not always possible to accommodate the preference)

Morning 8:30 – 11:30 Afternoon 12:00-15:00

Please select preferable time of ECCE session.

Deposit Policy

Yes No

I accept their policies and agree to pay the deposit to secure the place for my child. I understand that the deposit will be returned within the month after the ECCE registration has been approved by the Department of Children and Youth Affairs and Pobal. I accept the fact that deposit will not be returned in case when I cancel the booking within 2 months before the new school year so after the 25 June.

Print your name

Date: