Trinity Lutheran Nursery School
Registration
2012-2013
Child’s Name___________________________ Date of application_____________
Nickname______________________________ Birth Date____________________
Address________________________________
Phone_______________________
________________________________ Email address____________________________
Mothers’ Name__________________________ Work Number_________________
Occupation______________________________ Cell Phone___________________
Father’s Name___________________________ Work Number________________
Occupation______________________________ Cell Phone___________________
List of siblings, name and ages:
________________________ __________
________________________ __________
________________________ __________
________________________ __________
________________________ __________
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___________________________________
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 complete opposite page)
Please check:
Nursery Class ( 3 year old A.M. program) 9 to 11:30
2 day Monday and Wednesday class_____l____
2 day Tuesday and Thursday class___l______
(the 2 day Nursery class offers an optional 3rd day, Friday )
(if interested, please check here ___________)
3 day Tuesday, Wednesday, Thursday class_____
5 day class_____
Pre-K (4 year old A.M. program)9 to 11:30
5 day ______
4 day Monday thru Thursday class________
3 day Tuesday, Wednesday Thursday class_____
Transitional class ( older fours)
5 day Monday thru Thursday 8;45 to 1:45
Friday 8:45 to 11:30 _____full__
* Afternoon Kindergarten Enrichment program 11:45 to 2:30
4 day afternoon, Monday thru Thursday ___________
2 day afternoon…….Monday__ Tuesday__ Wednesday__ Thursday__
3 day afternoon…….Monday__ Tuesday__ Wednesday__ Thursday__
Fees:
Registration: Activity
5 day $ 40.00 Pre-k classes $22.00
4 day $ 40.00 Nursery classes $20.00
3 day $ 35.00
2 day $ 30.00
Arrival and Dismissal
A.M. classes 9 to 11:30
5 day pre-k transitional class 8:45 to 1:45 Monday thru Thursday ,8:45 to 11:30 Fridays
4 day kindergarten enrichment 11:45 to 2:30 Monday thru Thursday
Tuition fees:
2 day program $141.00
3 day program $ 178.00
4 day program $196.00
5 day program $ 237.00 (9 to 11:30)
5 day transitional program $270.00 (8:45 to 1:45)
At dismissal my child will be taken home by____________________________________-
Payment is due the first school day of each month for 9 months. The fee is $_______a month
Signature of Parent_______________________
Signature of Director_____________________
If you are interested in speaking with our Pastor about joining our church , please check here__________