Registration form for Nursery School

Registration form for Nursery School

                                   Trinity Lutheran Nursery School 



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____________


 Name __________________Phone__________


Doctor_______________________         Phone_______________

Dentist_______________________         Phone_______________

In case of an emergency, my child may be taken to ________________________(hospital)

Food sensitivities____________________________Does your child have asthma?___________


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,_____________________________


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 _______


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


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


    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.____________       _____________________      _________________


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


Please include a copy of your child’s inoculation record before school begins

          Please attach photo

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