Calvary Lutheran Preschool Registration
5 Yr old Pre K class (Monday thru Friday) _____ 8:30-11:30
4/5 Yr Old Class (Monday, Wednesday, Friday) ____ 8:30-11:00
3/4 Yr Old Class (Tuesday and Thursday) _____ 8:30-11:00
Child’s Name _______________________________________________________
(first) (middle) (last)
Child’s Address ______________________________________________________
Home phone number:_________________________________________________
Child’s date of birth (month/day/year): __________________________________
Father’s name ______________________Occupation _______________________
Mother’s name _____________________ Occupation_______________________
Work and cell phone numbers:
Father _____________________________ cell # ___________________________
Mother ____________________________ cell # ___________________________
Name by which your child prefers to be called:_____________________________
What name do you want your child to learn to print? _______________________
Child resides with (check one)
___both parents ___mother ___father ____other: _________________________
Names and ages of our other children in the family:
___Baptist ___Lutheran ___Pentecostal ___Catholic
___Methodist ___Episcopal ___non-denominational
___ other (please indicate)____________________________________
Do you and your child currently attend church? Yes ____ No___
Please note any disabilities, extreme fears or health information (i.e. allergies) which would help the staff in working with your child. Also, please note if you detect any hearing, speech or seeing difficulties in your child.
How did you hear about Calvary Lutheran Preschool?
____ advertisement/article in newspaper___ Calvary’s Preschool Sign
____Realtor ____other ___recommended by family or friend
Name of person who recommended you: __________________________
Please be sure to carefully read our Handbook.
Watch for an Orientation letter to come to you around the end of July.
Please call us with any changes in the information on this form.
All information on this form will be kept confidential.
Your signature:___________________________ Date: _____________
A $25 nonrefundable registration fee is required with this application