Applying for: *
Applying for:
Official Use Only
Date App Red'd:
Program (Circle one):
Child's Name *
Child's Name
Date of Birth *
Date of Birth
Sibling(s)
Sibling(s)
Mother's Name *
Mother's Name
Home Phone *
Home Phone
Business Phone *
Business Phone
Father's Name *
Father's Name
Home Phone *
Home Phone
Business Phone *
Business Phone
Thank you for taking time to fill out this application form completely. The information contained will be kept confidential. Please return Parts I and II with a non-refundable application fee of $ 100 to: Play Space Montessori, 1159 Building 2, National Road No2, Phnom Penh. Upon receipt of the completed application and fee (and school records, if applicable), PSM will acknowledge receipt via mail, and place your child’s name into our pool of applicants. In no instance will an applicant’s race, color, religious creed, disability, ancestry, national origin, age or gender be a factor in determining whether s/he is accepted into the school.