Enrollment Form 2022-2023 Preschool

ENROLLMENT FORM 2022-2023 PRESCHOOL
Please submit a check for $250 after this online form submission to the school office on or before May 7, 2022. Please note that this payment is non-refundable, even if your plans change. We welcome you back to the Emmaus Lutheran Family. Thank you for choosing our school and for entrusting your child to our care for another year.
Student Information
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
Address *

Street Address

Apartment or Suite Number

City State / Province

Postal / Zip Code
Preschool Attended (if applicable)
Contact Email Address *
example@example.com
Parent / Guardian Information
Father's Name

First Name Last Name
Father's Phone Number
Mother's Name

First Name Last Name
Mother's Phone Number
Guardian's Name

First Name Last Name
Guardian's Phone Number
Returning Student

I will not be returning for the 2022-2023 school term. I wish to receive a phone call to discuss the reasons for not returning to school.
Parent Consent
Parent / Guardian Signature *

Clear
Printed Name *
Relationship to Child *
NON-DISCRIMINATION POLICY: Emmaus Lutheran School and Preschool admits students of any race, color or national origin or ethnic origin to all of the rights, privileges, programs and activities generally made available to students in the school. Emmaus Lutheran School and Preschool does not discriminate on the basis of race, color, or national origin or ethnic origin in administration of its policies, admissions policies, and scholarship/financial aid programs and athletic and other school administered programs.
Emmaus Lutheran School | 840 South Almansor Street, Alhambra, Ca. 91801 | 626-289-3664
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ENROLLMENT FORM 2022-2023 PRESCHOOL

Student Information

Parent / Guardian Information

Parent Consent