Registration form Mothers’ Morning Out:

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_____________


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____________


Name__________________________________ Phone_______________



Doctor____________________   Phone_____________

Dentist____________________   Phone_____________

In case of an emergency, my child may be taken to _________________


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, ____________


I give my permission for _________________to participate in any class activity or trip during the school year thereby releasing the school from any liability.


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


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__________________________________________


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.____________       _____________________      _________________


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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