ALL SAINTS LUTHERAN PRESCHOOL

REGISTRATION FORM

PROGRAM:                    3 Year Old                                       PreK                                               PreK Plus                                      

Child’s Full Name                                                                                                                                                                                     

                                                      First                                               Middle                                                         Last

Nickname                                                                                             Date of Birth                                                                              

Address:                                                                                                                                                                                                       

                                Street Address                                                    City                                                    State                        Zip

Father’s Name                                                                                    Mother’s Name                                                                          

Home Phone                                                                                        Home Phone                                                                               

E-Mail Address_________________________________         E-Mail Address________________________________

Employed By                                                                                      Employed By                                                                             

Work Phone                                                                                        Work Phone                                                                               

Occupation                                                                                          Occupation                                                                                 

Siblings:

        Name                                                               Date of Birth                    Name                                                               Date of Birth

        Name                                                               Date of Birth                    Name                                                               Date of Birth

Father-Church Member at:                                                                                                                                                                    

Mother-Church Member at:                                                                                                                                                                   

Child-Church Member at:                                                                                                                                                                      

Child Attends Sunday School        Yes       No                                               Child Baptized        Yes       No

                                                                                Circle One                                                                                      Circle One

What are your child’s favorite activities:                                                                                                                                          

Is there anything special we should know about your child                                                                                                           

Previous Preschool Experience                                                                                                                                                            

A NON-REFUNDABLE enrollment fee of $50.00 and the first months tuition are required at time of registration. 
Registrations are accepted on a first come, first serve basis.  You are not considered enrolled until this form
has been completely filled out and fees have been paid.  September’s tuition will not be refunded after June 1^st.
If something does not apply please place a N/A on the line.

SIGNATURE                                                                                                                                                                                              

RELATIONSHIP                                                                                                               PHONE