Your Personal data: First Name *: Last Name *: Street: City: State: ZIP *: Phone: EMail *:

You are interested as: ? Student Parent Supporter Staff Volunteer Just curious

Child 1: Select Age 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years enrolled: ? Not yet Home schooled Public Waldorf Montessori Catholic/Traditional Other Name: Gender: ? Male Female Child 2: Select Age 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years enrolled: ? Not yet Home schooled Public Waldorf Montessori Catholic/Traditional Other Name: Gender: ? Male Female Child 3: Select Age 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years enrolled: ? Not yet Home schooled Public Waldorf Montessori Catholic/Traditional Other Name: Gender: ? Male Female

Which school philosophies are you currently considering? ? Only Sudbury Sudbury and some others Primarily others

When is the soonest you are planning to enroll your child/children in a school? ? ASAP Fall 2006 Fall 2007 Fall 2008 or later

How did you hear about us? ? Web Search Engine Sudbury Valley School Website Directory of Alternative Schools Directory of Local Schools Yellow Pages Mail Flyer Magazine/Newspaper Ad Magazine/Newspaper Article Radio/TV Marin County Fair Public Event Referral by Big Rock Student or Parent Referral from Other Private School Word of Mouth Other

Any Comment:

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