Trinity Lutheran Church

Preschool/Afterschool Programs

Registration Form

 

Child's Name _________________________ Date of Birth ____________ Grade Entering ______

Church Affiliation (if any) _______________________ Gender Male Female

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Mother's Name ______________________ Home Address ____________________________

HomePhone______________Work/cellphone_________________Email_____________________

Business Name/address ___________________________________________________________

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Father's Name____________________________Home Address__________________________

Home Phone _____________Work/cell phone_________________Email______________________

Business Name/address_____________________________________________________________

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

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Care Needed:

Preschool MondayTuesdayWednesday ThursdayFriday

Afterschool MondayTuesdayWednesday ThursdayFriday

Full day on School recess (afterschool only) All SomeNone

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Other relatives or friends who live with your child:

Name ___________________________________________Relationship______________________

Name ___________________________________________ Relationship_____________________

Name ___________________________________________ Relationship_____________________

 

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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 _________