Registration for MMO 2018-2019


                Trinity Lutheran MOTHERS Morning Out

                                Registration 2018-2019


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____________


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,Friday



2018-2019 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 $32.50 for the first day. The second day is $32.00 


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.____________       _____________________      _________________



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___________________________________________________




Please attach a current picture of your child





I give my permission for my child,________________________________to have their photo taken at school to be put on the school=s facebook page , and web page

signed____________________________   date____________