Faith Lutheran Church, PreSchool & AfterSchool (LCMS)

Student Full Name *


Student Nickname *


Street Address *


City, Zip *


Home Phone


Student Date of Birth *


Age Today *
3 years old
4 years old
5 years old

Class *
PreSchool 3/4
PreKindergarten

Gender *
Boy
Girl

Father Name *


Father Cell


Father Home Phone (if different)


Father’s Employer


Father’s Work Phone


Mother Name *


Mother Cell


Mother Home Phone (if different)


Mother’s Employer


Mother’s Work Phone


Person(s) with whom child lives *
Mother
Father
Both Parents
Other

Email Address


Emergency Contact 1 Name


Emergency Contact 1 Relationship to Child


Emergency Contact 1 Phone 1


Emergency Contact 1 Phone 2


Emergency Contact 2 Name


Emergency Contact 2 Relationship to Child


Emergency Contact 2 Phone 1


Emergency Contact 2 Phone 2


Family Doctor & Phone


Family Dentist & Phone


Sibilings Name(s) and Age(s)


Name of Church you Attend


Is your PreSchooler baptized?
Yes
No

Other Information? (including allergies or fears...)


Is it okay to use your child's picture in publications/websites affliated with Faith PreSchool?
Yes
No

Choice of Payment Plan?
One Payment for Full Year (In September 5% discount)
Two Payments (One in Sept/One in Jan 2% discount)
Nine Equal Monthly Payments (Sept-May)