ELNS Student Application 2019-2020

ELNS Application for Student Enrollment 2021-2022

Please fill out form completely. Submit the form online. Your application is not considered complete until we receive the application fee and/or new student fee. Fees are described at the bottom of this form. Once your fees have been paid, your application reviewed and accepted, you will be presented a contract for the 2021-2022 school year for signature. If you have any questions, please contact the director, Melinda Martin, at 804-282-7506 or elnsdirector@gmail.com.
Student Information
Student Name *

First Name Middle Name Last Name
Nickname (if applicable)
Birth Date *

Month Day Year
Gender *

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone (only enter if you have a landline home phone)

Area Code Phone Number
Primary Phone Number *

Area Code Phone Number
Primary Email Address *
Are you a member of Epiphany Lutheran Church? *

Yes No
The below information is about the child's guardians. If you are the child's legal guardians but not "mother" or "father", please just fill in the fields as you see fit and provide a note in the other information section explaining guardianship.
Mother's Name *

First Name Last Name
Mother's Email
Mother's Cell Phone

Area Code Phone Number
Mother's Employer
Mother's Work Phone

Area Code Phone Number
Father's Name *

First Name Last Name
Father's Email
Father's Cell Phone

Area Code Phone Number
Father's Employer
Father's Work Phone

Area Code Phone Number
Describe any special health or medical problems (i.e. allergies, physical limitations, etc.) your child may have (please make sure these issues are also documented on your child's health form): *
Please give any other information that you feel would be helpful to your child's teacher, including sibling names and ages, language spoken at home if not English, etc. This information will be kept confidential within the school staff. Please let us know anything that may affect your child's learning experience here at ELNS. *
How did you hear about ELNS (internet, friend, currently enrolled, etc)? If a friend referred you, please let us know their name. If you found us on the internet, what site did you find us on? *
Emergency Contacts

Please include anyone that is authorized to pick your child up from school. If your child needs to go home early, this is the list of people we will call if the guardians listed above are not available. You do not need to put in your information again, this is for additional emergency contact information besides the guardians listed above. If you need to list more than 4, please come to the school office to add additional names.
Emergency Contact Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship to Student *
Emergency Contact Name

First Name Last Name
Phone Number

Area Code Phone Number
Relationship to Student
Emergency Contact Name

First Name Last Name
Phone Number

Area Code Phone Number
Relationship to Student
Emergency Contact Name

First Name Last Name
Phone Number

Area Code Phone Number
Relationship to Student
Program & Day Preferences

Placement will be made based upon many factors including but not limited to your child's birth date, space availability, and personality/temperament. Day preferences are honored on a first come, first served basis. All ages are based on the age your child will be on Sept. 30, 2021.
Tuition Rates:

1-2 year old classes:

1 day/week - $1030 per year (1 year old class only)

2 day/week - $1905 per year

3 day/week - $2625 per year

4 day/week - $3400 per year

5 day/week - $4120 per year

3-5 years old classes:

3 day/week - $2500 per year

4 day/week - $3010 per year

5 day/week - $3710 per year
How many days would you like to enroll your child? *

1 day per week - 12-23 months old only 2 days per week - 12 month - 2 years old only 3 days per week - any age 4 days per week - any age 5 days per week - any age
Which 1 day of the week do you want your child to attend? *

Monday Tuesday Wednesday Thursday Friday
Which 2 days of the week do you want your child to attend? *

Monday Tuesday Wednesday Thursday Friday
Which 3 days of the week do you want your child to attend? *

Monday Tuesday Wednesday Thursday Friday
Which 4 days of the week do you want your child to attend? *

Monday Tuesday Wednesday Thursday Friday
Fees:

Once your application is submitted, the school director will review the information and then email you an invoice for the application fee and new student fee (if applicable). Those fees can be paid online via a link in the invoice or paid directly to the school office (in person or by U.S. mail). Your application will not be considered complete until the invoice is paid. If you are sending payment via U.S. Mail, our mailing address is Epiphany Lutheran Nursery School, 1400 Horsepen Rd., Richmond, VA 23226.

Application Fee: $35 paid every year (ELNS staff and Epiphany Lutheran Church members are exempt from application fee)

New Student Fee: $50 paid the first year an application is submitted for a child (no exemptions)
Should be Empty:

ELNS Application for Student Enrollment 2021-2022

Student Information

Emergency Contacts

Program & Day Preferences