Registration form for Nursery School
Trinity Lutheran Nursery School
Registration
2020-2021
Child’s Name___________________________ Date of application_____________
Nickname______________________________ Birth Date____________________
Address________________________________ Phone_______________________
________________________________ Email address____________________________
Mothers’ Name__________________________ Work Number_________________
Occupation______________________________ Cell Phone___________________
Father’s Name___________________________ Work Number________________
Occupation______________________________ Cell Phone___________________
List of siblings, name , school presently attending and ages:
________________________ __________ _________________________________
________________________ __________ ________________________________
________________________ __________ ________________________________
________________________ __________ ________________________________
________________________ __________ ________________________________
Religious affiliation___________________ Church Name___________
Nearest neighbor of relative in case of an emergency:
Name__________________ Phone____________
Address_________________________________________
Name __________________Phone__________
Address________________
Doctor_______________________ Phone_______________
Dentist_______________________ Phone_______________
In case of an emergency, my child may be taken to ________________________(hospital)
Food sensitivities____________________________Does your child have asthma?___________
Allergies___________________________________
Does your child have an inhaler? _____ or epi pen? ___________
Any important information you would like to share about your child such as habits, likes, dislikes, illnesses,___________________________________________________________________
I give my permission for the school to administer first aid to my child,_____________________________
Signed_____________________________.
I give my permission for ____________________________to participate in any class activity or trip during the school year thereby releasing the school from any liability. Signed_____________________Date__________
Return the Registration form and Pick up form with the Registration fee
Please return a copy of your child’s inoculation schedule before classes begins in September
Please check:
Nursery Class ( 3 year old A.M. program) 9 to 11:30
2 day Monday and Wednesday class_________
2 day Tuesday and Thursday class_________
(the 2 day Nursery class offers an optional 3rd day, Friday )
(if interested, please check here ___________)
3 day Tuesday, Wednesday, Thursday class_____(optional 4th day on Friday)______
5 day Nursery class______________
Pre-K (4 year old A.M. program)9 to 11:30
5 day Monday thru Friday________
4 day Monday thru Thursday class________
3 day Tuesday, Wednesday Thursday class_____
Pre-K class. 8:45 to 1:45
5T day Monday thru Thursday 8:45 to 1:45
Friday 8:45 to 11:30 _______
Fees:
Registration: Activity
5 day $ 40.00 Pre-k classes $22.00
4 day $ 40.00 Nursery classes $20.00
3 day $ 35.00
2 day $ 30.00
Arrival and Dismissal
A.M. classes 9 to 11:30
5 day pre-k class 8:45 to 1:45 Monday thru Thursday ,
8:45 to 11:30 Fridays
**EARLY MORNING ARRIVAL 8:00FREE*************
Tuition fees:
2 day program $190.00
3 day program $ 225.00
4 day program $255.00
5 day program $ 285.00 (9 to 11:30)
5 day transitional program $320.00 (8:45 to 1:45)…Friday (9 to 11:30)
******Lunch Bunch..11:30 to 1:30..fee is $10.**************
******LATE SHOW 1:30 to 3:00….fee is $10 3:00 to 5:00…the fee is $10.00
Payment is due the first school day of each month for 9 months. The fee is $_______a month
Signature of Parent_______________________
Does your child receive services from DCIU or Early Intervention?______
If your child has an IEP, please give a copy to the teacher and one to the director
If you do not have a home church , would you like to have the Pastor visit you? Yes or No
2020-2021
Trinity Lutheran Nursery School & Mothers’ Morning Out
Child’s Name_________________________________
Days and Room child is enrolled _______________________________________
Emergency Contact information:
In the order of notification (include parents)
Name Relation Cell number
1.___________ __________________ ______________
2.___________ ___________________ ______________
3.___________ ____________________ _______________
4.___________ ___________________- ________________
People Permitted to pick up your child from school:
Name Relation Cell Number
1._____________ __________________ _________________
2._____________ ___________________ ________________
3._____________ ____________________ ________________
4.____________ _____________________ _________________
Allergies:__________________________________________________
Food Sensitivities___________________________________________
Does your child have asthma? yes or no
Does your child have an inhaler ? Yes or no Does your child have an epi pen? yes or no
e mail address________________________________________
Photo release:
Permission for my child,____________________________to have their picture taken for publication on the church’s web site, school’s facebook page and the local paper
___Yes, I give my permission
___No, I do not give my permission
Signed________________________________Date___________________
Please include a copy of your child’s inoculation record before school begins
Please attach photo
