2017-2018 Pick up Info


    Trinity Lutheran Nursery School & Mothers’ Morning Out


Child’s Name_________________________________



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 attach photo