MMO Registration Form 2017-2018



                            Trinity Lutheran Nursery School & Mothers’ Morning Out

                                                         Registration 2017-2018

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_______________

Address__________________________             Address__________________________________


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, ____________









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



2017-2018 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 $32.00 for the first day. The second day is $31.50  


Arrival        9:00 A.M.

Dismissal   11:30 A.M.


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






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___________________________________________________



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__________

Return the Registration form and Pick up form with the Registration fee

Please return a copy of your child’s inoculation schedule before classes begins in September    



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 a photo