Kindergarten Enrichment 2017-2018 AM-PM

              Trinity Lutheran Nursery School & Mothers’ Morning Out

              Kindergarten Enrichment         Registration 2017-2018

 

Child’s Name___________________ Kindergarten School________________________

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 child attends

______________________     ________ _________________

______________________     ___________________________

______________________     __________________________

______________________     _________________________

 

Religious affiliation_____________________________________

 

Nearest neighbor of relative in case of an emergency:

Name________________Phone____________   Name________________Phone_______________

Address__________________________             Address__________________________________

 

Doctor____________________   Phone_____________

Dentist____________________   Phone_____________

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

(hospital)

 

Food sensitivities______________________________Does your child have asthma?___

Allergies_____________________________________Does your child have an epi_pen ____or inhaler?___

 

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(monthly payment)

___2 days  $170.00

___3 days  $210.00

___ 4 days  $240.00

___ 5 days  $270.00

___Morning Session

___Afternoon Session

Manoa and Lynnewood bus to Trinity…you must notify the school

8:00 morning drop off__________Free

3:00 to 5:00…………$10.00

 

Trinity Lutheran Nursery School                                  Kindergarten Enrichment

 

 

 

Child’s full name_________________________________________________

Mom’s Cell Phone____________________________________

 

Emergency Contact information:

In the order of notification:

Name                                                        Relation                                          Phone Number

1._________________________________________________________________________

2._________________________________________________________________________

3._________________________________________________________________________

 

People permitted to pick up your child from school:

Name                                                        Relation                                          Phone Number

1._________________________________________________________________________

2._________________________________________________________________________

3._________________________________________________________________________

4._________________________________________________________________________

 

Allergies:__________________________________________________

Does your child have asthma? Yes or no          Does your child have an epi pen? Yes or no

Does you child have an inhaler? Yes or no

 

email address______________________________________________________

 

Photo Release:

Permission for my child, ____________________________to have their picture taken for publication on the church’s web site, the school’s facebook page and the local paper

Signed__________________________Date_____________

 

 

* attach photo