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Trinity Lutheran Church

Preschool/Afterschool Programs

Pre-Enrollment Information Form

Child's Name _____________________________ Date of Birth ____________ ________

_______________________ Gender Male Female


Mother's Name _________________________ Home Address _________________________________

Home Phone___________________Work/cell phone__________________Email______________________ _______________________________________________________


Father's Name_________________________________Home Address__________________________

Home Phone _____________Work/cell phone__________________Email______________________

Business Name/address________________________________________________________________

Child lives with: Both ParentsMother Father Guardian (name)___________________________


Care Needed:

Preschool MondayTuesdayWednesday ThursdayFriday

Afterschool MondayTuesdayWednesday ThursdayFriday

Full day on School recess (afterschool only) All SomeNone


Other relatives or friends who live with your child:

Name ___________________________________________Relationship________________________

Name ___________________________________________ Relationship________________________

Name ___________________________________________ Relationship________________________

Allergies: ____________________________________________________________________________

List your child's favorite activities, hobbies, sports, people, food, etc:

Afterschool students only: School attending__________________Bus # ______ Teacher __________

Authorization to Photograph: I give permission for my child to be photographed or video-taped during school activities/events for newspapers or other publicity. YesNo Parent's Initials _________