Registration form Mothers’ Morning Out:
Trinity Lutheran MOTHERS’ Morning Out
Registration 2020-2021
Child=s Name___________________ Date of Application_________
Nickname____________________________ Birth date_________________
Address________________________ Home Phone____________________
_________________________ Email _____________________
Mother’s Name__________________ Work Number_____________
Occupation___________________
Cell Phone______________________________
Father’s Name___________________ Work Number_____________
Occupation______________________ Cell Phone______________
List of siblings, name, ages & school:
______________________ ________
______________________ ________ ________________
______________________ ________
______________________ ________ ________________
______________________ ________
Religious affiliation_ (name of church)____________________________________
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?___ inhaler?___
Allergies_____________________________________Does your child have an 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___________________
Please Check:
Room B2 years old by September 1: Monday Tuesday Wednesday Thursday Friday
Room AUnder 2 years old by Sept. 1: Monday Tuesday Wednesday Thursday,
2020-2021 School Year
Registration fee due at the time of application $ 25.00
The school year is divided into 4 sessions. Payments are made during the months of September, November, February and April. Tuition is based on the number of days per week your child participates in the program. Bills will be posted outside the classroom at the beginning of each session. The fee per day is $33.50 for the first day. The second day is $33.00
Arrival 9:00 A.M.
Dismissal 11:30 A.M.
At dismissal, my child will be taken home by: ________________________________________________________________
At dismissal, we need to see a driver=s license as proof of identification.
The teachers will list the names of people permitted to pick up the child in the classroom.
Signature of parent_______________________________
Signature of director______________________________
Early morning drop off……..8:00 …..FREE
Lunch Bunch…..11:30 to 1:30 …..$10.00
PLEASE BRING A COPY OF YOUR CHILD=S INOCULATION
Does your child receive services from Early Intervention? Yes No
If yes, please send us a copy of the IEP……..Thank you
If you currently do not have a home church, would you like a visit with the Pastor of Trinity? Yes or No
Trinity Lutheran Nursery School & Mothers’ Morning Out
Child’s Full Name__________________________________________
Class________________________________
Emergency Contact information:
In the order of notification (list mom as #1)
Name Relation Phone number
1.___________ __________________ ______________
2.___________ ___________________ ______________
3.___________ ____________________ _______________
People Permitted to pick up your child from school:
Name Relation Phone
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
