Montessori House Belgium

Please fill in the Registration Form below.
Should you prefer to fax this form, please choose the PDF version.

Online Version	PDF Version
Application/Admission Form Registration Form Medical History Form	Application/Admission Form Registration Form Medical History Form

REGISTRATION FORM

REQUIRED FIELDS ARE BOLD!

I / We would like to register my child
Child's Name:
Date Of Birth:
In the following programme for the Academic Year 2006-2007.

(Please tick the appropriate box)
NURSERY 1 A	3 Mornings
NURSERY 1 B	5 Mornings
NURSERY 2	5 Mornings & 2 Afternoons
NURSERY 3	5 Mornings & 4 Afternoons
PRIMARY	5 Mornings & 4 Afternoons
ELEMENTARY	5 Mornings & 4 Afternoons

I will transfer 500 euros as a non-refundable enrolment fee by:
bank transfer	cheque
CBC Banque SA Dreve Richelle 159, Waterloo 1410 Account No.: 192-5170671-31 SWIFT Code: IBAN: BE 04 BIC: CREGBEBB

INVOICING ADRESS