First Lutheran : Registration 2021-22

Primary Parent/Guardian Last Name*

Select No. of students*

Primary Parent/Guardian Email

example@example.com

Name of Student 1*

First NameMiddle NameLast NameSuffix

Nick Name

If different from first name

Gender

Incoming Grade for 2021-2022*

Date of Birth*

Date

Student Lives With*

Mother & FatherMotherFatherOther

Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number*

Student 1 Personal Information

Ethnicity*

Race*

Birth Place*

City, State, Country

Gender*

Primary Language Spoken at home *

What Language did your child first learn *

What Language does your child use most frequently at home?*

What Language do the adults at home speak most often?*

What Language do you use most often when speaking to your child?*

Number of Siblings*

Sibling 1 Name*

Birth Date*

Date

Sibling 2 Name*

Birth Date*

Date

Sibling 3 Name*

Birth Date*

Date

Sibling 4 Name*

Birth Date*

Date

Religion*

Name of Church of Attendance/Membership, if applicable

Authorize*

If authorized persons cannot be reached, I wish my child taken to the nearest hospital.In case of minor injury, I authorize that First Aid be administered by a qualified person.

List Any Food/Medication/Insect Allergies:

List any dietary restrictions below

Pre-Existing Medical Conditions:

Do you intend to make an inhaler available for school?*

YesNoN/A

If the student is to be allowed to carry the inhaler with him or her, click here for the Authorization for Student Self-Administration of inhaled Medication form. Complete the attached form and submit to the School Office by email (robertsonm@flchurch.org) or in person.

Medications child takes *

This includes any medication that your child takes regularly whether at home or at school. This information will help paramedics should they need to administer medical care to your child.

Please be advised that medication cannot be given to a student at school without proper authorization from the student's physician and parents. This includes all medications, whether they are over-the-counter drugs or prescription drugs. There will be no exceptions to this rule. Proper authorization can be obtained by completing the appropriate forms below:

If the student will require prescription medication during school hours, click here for the Authorization to Administer Prescription Medications Form.
To authorize the school to administer over-the-counter medications to the student when needed, click to access Transitional Kindergarten to 3rd grade or 4th through 8th grade for the appropriate Authorization to Administer Over-the-Counter Form.
For 7th-grade students and newly enrolled 8th-grade students, click here for TDAP notice.

MEDICAL AUTHORIZATION

As parent/legal guardian of the above child, I give full consent to the personnel of First Lutheran School and/or the First Lutheran School Health Office Staff to render medical treatment and any first aid deemed necessary to my child. I will freely disclose any information about my child and any health-related conditions that my child have, including drug and food allergies, and any medications that the child is taking. I understand that this information is necessary to assist staff in providing the proper treatment for my child. In addition, I understand that First Lutheran School doesn't provide health care by a licensed health care professional at all times. I hereby agree to release the school from any and all claims that may result from the rendering of medical care or first aid.

Do you agree?*

Parent/Guardian Signature*

Physician's Name*

Phone Number

In the event of a major medical emergency, paramedics will be called and children will be transported to the first available emergency room.

As the parent of the minor child list above, I consent to any x-ray examination, anesthetics, medical or surgical diagnostics, or treatment procedure deemed necessary for my child's treatment by the physician named above or the emergency physician on duty at a licensed hospital.

It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage said physicians to exercise their best judgment as to requirements of such diagnosis or treatment. This consent is effective for the current school year. (September 1 to August 31).

Do you agree?*

Parent/Guardian Signature*

FLS Parent Handbook

Click here for the FLS Parent Handbook. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the FLS Parent Handbook. I also acknowledge that the First Lutheran School Board may amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?*

Parent/Guardian Signature*

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

Click Here for the Addendum to the Parent Handbook 2021-2022. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and Procedures set forth in the attached addendum. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?*

Parent/Guardian Signature*

FLASH (DAY CARE) EXPECTED NEEDS

Please select your choice below indicating your expected FLASH needs for the year. Please note: Monthly FLASH day care charges are added to monthly tuition charges and may be paid in two ways: In one lump sum at the beginning of the year, with a 3% discount; or through the SMART tuition management service. SMART payments are made a month in advance, on the 10th day of each month from August to May.

FLASH Needs:

AM/PM: Before & After School 7-8:10 am. & 3-6. p.m, $313/month for first child; $298/month for additional childAM ONLY: Before School Only 7-8:10 a.m, $193/month for first child; $183/month for additional childPM ONLY: After School Only 3-6 p.m. $264/month for first child; $250/month for additional child.OCCASIONAL: $9 per hour which will be invoiced on your SMART account. Not valid for holiday sessions.I do not expect to need day care for my child.

MILK ORDERS

Are you ordering milk for this child?

YesNo

If you choose to order milk for your child, please select “Agree” and complete your name and the date below. Low-fat milk is offered to students in Transitional K - grade 8 for lunch each day for $50.00 for the entire School year. (The State Office of Child Nutrition Services supplements this amount to cover the total cost.)

Please note: These milk orders are in addition to milk that children receive as a beverage choice when they order from Choice Lunch.

By selecting “I Agree,” you acknowledge that you will be invoiced $50 for milk on your October Smart Tuition account.

Do you agree?*

Parent/Guardian Signature*

Name of Student 2*

First NameMiddle NameLast Name

Preferred Name

If different from first name

Incoming Grade for 2021-2022*

Birth Date*

Date

Student Lives With*

Mother & FatherMotherFatherOther

Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number*

Second Address if parents have separate households

Student 2 Personal Information

Are you a member of First Lutheran Church?

YesNo

Ethnicity*

Race*

Birth Place*

City, State, Country

Gender*

Primary Language Spoken at home *

What Language did your child first learn *

What Language does your child use most frequently at home?*

What Language do the adults at home speak most often?*

What Language do you use most often when speaking to your child?*

Number of Siblings*

Sibling 1 Name*

Birth Date*

Date

Sibling 2 Name*

Birth Date*

Date

Sibling 3 Name*

Birth Date*

Date

Sibling 4 Name*

Birth Date*

Date

Religion*

Name of Church of Attendance/Membership, if applicable

Authorize*

If authorized persons cannot be reached, I wish my child taken to the nearest hospital.In case of minor injury, I authorize that First Aid be administered by a qualified person.

List Any Food/Medication/Insect Allergies:

List any dietary restrictions below

Pre-Existing Medical Conditions:

Do you intend to make an inhaler available for school?*

YesNo

If the student is to be allowed to carry the inhaler with him or her, click here for the Authorization for Student Self-Administration of inhaled Medication form.

Medications child takes *

This includes any medication that your child takes regularly whether at home or at school. This information will help paramedics should they need to administer medical care to your child.

Please be advised that medication cannot be given to a student at school without proper authorization from the student's physician and parents. This includes all medications, whether they are over-the-counter drugs or prescription drugs. There will be no exceptions to this rule. Proper authorization can be obtained by completing the appropriate forms below:

If the student will require prescription medication during school hours, click here for the Authorization to Administer Prescription Medications Form.
To authorize the school to administer over-the-counter medications to the student when needed, click to access Transitional Kindergarten to 3rd grade or 4th through 8th grade for the appropriate Authorization to Administer Over-the-Counter Form.
For 7th-grade students and newly enrolled 8th-grade students, click here for TDAP notice.

MEDICAL AUTHORIZATION

As parent/legal guardian of the above child, I give full consent to the personnel of First Lutheran School and/or the First Lutheran School Health Office Staff to render medical treatment and any first aid deemed necessary to my child. I will freely disclose any information about my child and any health-related conditions that my child have, including drug and food allergies, and any medications that the child is taking. I understand that this information is necessary to assist staff in providing the proper treatment for my child. In addition, I understand that First Lutheran School doesn't provide health care by a licensed health care professional at all times. I hereby agree to release the school from any and all claims that may result from the rendering of medical care or first aid.

Do you agree?*

Parent/Guardian Signature*

Physician's Name*

Phone Number

In the event of a major medical emergency, paramedics will be called and children will be transported to the first available emergency room.

As the parent of the minor child list above, I consent to any x-ray examination, anesthetics, medical or surgical diagnostics, or treatment procedure deemed necessary for my child's treatment by the physician named above or the emergency physician on duty at a licensed hospital.

It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage said physicians to exercise their best judgment as to requirements of such diagnosis or treatment. This consent is effective for the current school year. (September 1 to August 31).

Do you agree?*

Parent/Guardian Signature*

FLS Parent Handbook

Click here for the FLS Parent Handbook. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the FLS Parent Handbook. I also acknowledge that the First Lutheran School Board may amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?*

Parent/Guardian Signature*

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

Click Here for the Addendum to the Parent Handbook 2021-2022. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and Procedures set forth in the attached addendum. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?*

Parent/Guardian Signature*

FLASH (DAY CARE) EXPECTED NEEDS

Please select your choice below indicating your expected FLASH needs for the year. Please note: Monthly FLASH day care charges are added to monthly tuition charges and may be paid in two ways: In one lump sum at the beginning of the year, with a 3% discount; or through the SMART tuition management service. SMART payments are made a month in advance, on the 10th day of each month from August to May.

FLASH Needs:

AM/PM: Before & After School 7-8:10 am. & 3-6. p.m, $313/month for first child; $298/month for additional childAM ONLY: Before School Only 7-8:10 a.m, $193/month for first child; $183/month for additional childPM ONLY: After School Only 3-6 p.m. $264/month for first child; $250/month for additional child.OCCASIONAL: $9 per hour which will be invoiced on your SMART account. Not valid for holiday sessions.I do not expect to need day care for my child.

MILK ORDERS

Are you ordering milk for this child?

YesNo

If you choose to order milk for your child, please select “Agree” and complete your name and the date below. Low-fat milk is offered to students in Transitional K - grade 8 for lunch each day for $50.00 for the entire School year. (The State Office of Child Nutrition Services supplements this amount to cover the total cost.)

Please note: These milk orders are in addition to milk that children receive as a beverage choice when they order from Choice Lunch.

By selecting “I Agree,” you acknowledge that you will be invoiced $50 for milk on your October Smart Tuition account.

Do you agree?*

Parent/Guardian Signature*

Name of Student 3*

First NameMiddle NameLast Name

Preferred Name

If different from first name

Incoming Grade for 2021-2022*

Birth Date*

Date

Student Lives With*

Mother & FatherMotherFatherOther

Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number*

Second Address if parents have separate households

Student 3 Personal Information

Are you a member of First Lutheran Church?

YesNo

Ethnicity*

Race*

Birth Place*

City, State, Country

Gender*

Primary Language Spoken at home *

What Language did your child first learn *

What Language does your child use most frequently at home?*

What Language do the adults at home speak most often?*

What Language do you use most often when speaking to your child?*

Number of Siblings*

Sibling 1 Name*

Birth Date*

Date

Sibling 2 Name*

Birth Date*

Date

Sibling 3 Name*

Birth Date*

Date

Sibling 4 Name*

Birth Date*

Date

Religion*

Name of Church of Attendance/Membership, if applicable

Authorize*

If authorized persons cannot be reached, I wish my child taken to the nearest hospital.In case of minor injury, I authorize that First Aid be administered by a qualified person.

List Any Food/Medication/Insect Allergies:

List any dietary restrictions below

Pre-Existing Medical Conditions:

Do you intend to make an inhaler available for school?*

YesNo

If the student is to be allowed to carry the inhaler with him or her, click here for the Authorization for Student Self-Administration of inhaled Medication form.

Medications child takes *

This includes any medication that your child takes regularly whether at home or at school. This information will help paramedics should they need to administer medical care to your child.

Please be advised that medication cannot be given to a student at school without proper authorization from the student's physician and parents. This includes all medications, whether they are over-the-counter drugs or prescription drugs. There will be no exceptions to this rule. Proper authorization can be obtained by completing the appropriate forms below:

If the student will require prescription medication during school hours, click here for the Authorization to Administer Prescription Medications Form.
To authorize the school to administer over-the-counter medications to the student when needed, click to access Transitional Kindergarten to 3rd grade or 4th through 8th grade for the appropriate Authorization to Administer Over-the-Counter Form.
For 7th-grade students and newly enrolled 8th-grade students, click here for TDAP notice.

MEDICAL AUTHORIZATION

As parent/legal guardian of the above child, I give full consent to the personnel of First Lutheran School and/or the First Lutheran School Health Office Staff to render medical treatment and any first aid deemed necessary to my child. I will freely disclose any information about my child and any health-related conditions that my child have, including drug and food allergies, and any medications that the child is taking. I understand that this information is necessary to assist staff in providing the proper treatment for my child. In addition, I understand that First Lutheran School doesn't provide health care by a licensed health care professional at all times. I hereby agree to release the school from any and all claims that may result from the rendering of medical care or first aid.

Do you agree?*

Parent/Guardian Signature*

Physician's Name*

Phone Number

In the event of a major medical emergency, paramedics will be called and children will be transported to the first available emergency room.

As the parent of the minor child list above, I consent to any x-ray examination, anesthetics, medical or surgical diagnostics, or treatment procedure deemed necessary for my child's treatment by the physician named above or the emergency physician on duty at a licensed hospital.

It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage said physicians to exercise their best judgment as to requirements of such diagnosis or treatment. This consent is effective for the current school year. (September 1 to August 31).

Do you agree?*

Parent/Guardian Signature*

FLS Parent Handbook

Click here for the FLS Parent Handbook. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the FLS Parent Handbook. I also acknowledge that the First Lutheran School Board may amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?*

Parent/Guardian Signature*

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

Click Here for the Addendum to the Parent Handbook 2021-2022. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and Procedures set forth in the attached addendum. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?*

Parent/Guardian Signature*

FLASH (DAY CARE) EXPECTED NEEDS

Please select your choice below indicating your expected FLASH needs for the year. Please note: Monthly FLASH day care charges are added to monthly tuition charges and may be paid in two ways: In one lump sum at the beginning of the year, with a 3% discount; or through the SMART tuition management service. SMART payments are made a month in advance, on the 10th day of each month from August to May.

FLASH Needs:

AM/PM: Before & After School 7-8:10 am. & 3-6. p.m, $313/month for first child; $298/month for additional childAM ONLY: Before School Only 7-8:10 a.m, $193/month for first child; $183/month for additional childPM ONLY: After School Only 3-6 p.m. $264/month for first child; $250/month for additional child.OCCASIONAL: $9 per hour which will be invoiced on your SMART account. Not valid for holiday sessions.I do not expect to need day care for my child.

MILK ORDERS

Are you ordering milk for this child?

YesNo

If you choose to order milk for your child, please select “Agree” and complete your name and the date below. Low-fat milk is offered to students in Transitional K - grade 8 for lunch each day for $50.00 for the entire School year. (The State Office of Child Nutrition Services supplements this amount to cover the total cost.)

Please note: These milk orders are in addition to milk that children receive as a beverage choice when they order from Choice Lunch.

By selecting “I Agree,” you acknowledge that you will be invoiced $50 for milk on your October Smart Tuition account.

Do you agree?*

Parent/Guardian Signature*

Name of Student 4*

First NameMiddle NameLast Name

Preferred Name

If different from first name

Incoming Grade for 2021-2022*

Birth Date*

Date

Student Lives With*

Mother & FatherMotherFatherOther

Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number*

Second Address if parents have separate households

Student 4 Personal Information

Are you a member of First Lutheran Church?

YesNo

Ethnicity*

Race*

Birth Place*

City, State, Country

Gender*

Primary Language Spoken at home *

What Language did your child first learn *

What Language does your child use most frequently at home?*

What Language do the adults at home speak most often?*

What Language do you use most often when speaking to your child?*

Number of Siblings*

Sibling 1 Name*

Birth Date*

Date

Sibling 2 Name*

Birth Date*

Date

Sibling 3 Name*

Birth Date*

Date

Sibling 4 Name*

Birth Date*

Date

Religion*

Name of Church of Attendance/Membership, if applicable

Authorize*

If authorized persons cannot be reached, I wish my child taken to the nearest hospital.In case of minor injury, I authorize that First Aid be administered by a qualified person.

List Any Food/Medication/Insect Allergies:

List any dietary restrictions below

Pre-Existing Medical Conditions:

Do you intend to make an inhaler available for school?*

YesNo

If the student is to be allowed to carry the inhaler with him or her, click here for the Authorization for Student Self-Administration of inhaled Medication form.

Medications child takes *

This includes any medication that your child takes regularly whether at home or at school. This information will help paramedics should they need to administer medical care to your child.

Please be advised that medication cannot be given to a student at school without proper authorization from the student's physician and parents. This includes all medications, whether they are over-the-counter drugs or prescription drugs. There will be no exceptions to this rule. Proper authorization can be obtained by completing the appropriate forms below:

If the student will require prescription medication during school hours, click here for the Authorization to Administer Prescription Medications Form.
To authorize the school to administer over-the-counter medications to the student when needed, click to access Transitional Kindergarten to 3rd grade or 4th through 8th grade for the appropriate Authorization to Administer Over-the-Counter Form.
For 7th-grade students and newly enrolled 8th-grade students, click here for TDAP notice.

MEDICAL AUTHORIZATION

As parent/legal guardian of the above child, I give full consent to the personnel of First Lutheran School and/or the First Lutheran School Health Office Staff to render medical treatment and any first aid deemed necessary to my child. I will freely disclose any information about my child and any health-related conditions that my child have, including drug and food allergies, and any medications that the child is taking. I understand that this information is necessary to assist staff in providing the proper treatment for my child. In addition, I understand that First Lutheran School doesn't provide health care by a licensed health care professional at all times. I hereby agree to release the school from any and all claims that may result from the rendering of medical care or first aid.

Do you agree?*

Parent/Guardian Signature*

Physician's Name*

Phone Number

In the event of a major medical emergency, paramedics will be called and children will be transported to the first available emergency room.

As the parent of the minor child list above, I consent to any x-ray examination, anesthetics, medical or surgical diagnostics, or treatment procedure deemed necessary for my child's treatment by the physician named above or the emergency physician on duty at a licensed hospital.

It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage said physicians to exercise their best judgment as to requirements of such diagnosis or treatment. This consent is effective for the current school year. (September 1 to August 31).

Do you agree?*

Parent/Guardian Signature*

FLS Parent Handbook

Click here for the FLS Parent Handbook. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the FLS Parent Handbook. I also acknowledge that the First Lutheran School Board may amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?*

Parent/Guardian Signature*

ADDENDUM TO PARENT HANDBOOK- SAFETY PROCEDURES IN RESPONSE TO COVID-19

Click Here for the Addendum to the Parent Handbook 2021-2022. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and Procedures set forth in the attached addendum. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?*

Parent/Guardian Signature*

FLASH (DAY CARE) EXPECTED NEEDS

Please select your choice below indicating your expected FLASH needs for the year. Please note: Monthly FLASH day care charges are added to monthly tuition charges and may be paid in two ways: In one lump sum at the beginning of the year, with a 3% discount; or through the SMART tuition management service. SMART payments are made a month in advance, on the 10th day of each month from August to May.

FLASH Needs:*

AM/PM: Before & After School 7-8:10 am. & 3-6. p.m, $313/month for first child; $298/month for additional childAM ONLY: Before School Only 7-8:10 a.m, $193/month for first child; $183/month for additional childPM ONLY: After School Only 3-6 p.m. $264/month for first child; $250/month for additional child.OCCASIONAL: $9 per hour which will be invoiced on your SMART account. Not valid for holiday sessions.I do not expect to need day care for my child.

MILK ORDERS

Are you ordering milk for this child?

YesNo

If you choose to order milk for your child, please select “Agree” and complete your name and the date below. Low-fat milk is offered to students in Transitional K - grade 8 for lunch each day for $50.00 for the entire School year. (The State Office of Child Nutrition Services supplements this amount to cover the total cost.)

Please note: These milk orders are in addition to milk that children receive as a beverage choice when they order from Choice Lunch.

By selecting “I Agree,” you acknowledge that you will be invoiced $50 for milk on your October Smart Tuition account.

Do you agree?*

Parent/Guardian Signature*

Parents/guardians will be notified first in case of illness or injury for pick-up. Others picking up students must be at least 18 years old and bring a photo ID. Please indicate below who will be available to pick up your child in the order you wish them contacted. Please list their daytime phone numbers.

Student Emergency Contacts *

Name

Relationship with Child*

Phone Number*

Secondary Phone Number*

Address*

Emergency contact 2

Name

Relation with Child

Phone Number

Secondary Phone Number

Address

Emergency contact 3

Name

Relation with child

Phone Number

Secondary Phone Number

Address

Emergency contact 4

Name

Relation with child

Phone Number

Secondary Phone Number

Address

Emergency contact 5

Name

Relation with child

Phone Number

Secondary Phone Number

Address

Non-Emergency Student Release Permission

The following contacts listed below may pick up my child on any school day without additional notification to the school.

Name 1

Phone Number

Name 2

Phone Number

Name 3

Phone Number

Name 4

Phone Number

I understand the above student release permission.

COVID-19 ACKNOWLEDGEMENT AND DISCLOSURE

Click here for the COVID-19 Public Health Emergency School Attendance Acknowledgement and Disclosure. I agree as part of my contractual agreement with First Lutheran to abide by all the policies and procedures set forth in the attached disclosure. I also acknowledge that the First Lutheran School Board May amend any and all policies as deemed necessary for the safety and education of the students.

Do you agree?*

Parent/Guardian Signature*

Never Release To Information

My child may never be released to the following:

Contact 1

Name

Relationship with Child

Phone Number

Address

Relationship with Child

Contact 2

Name

Phone Number

Address

Emergency contact 5

Name

Relation with child

Phone Number

Secondary Phone Number

Address

Out-of-state Contact

Name*

Relation with child*

Phone Number*

What State?*

Street Address

Street Address Line 2

State

H.U.G. Fee, Family Commitment Fee (FCF)

Every FLS family is required to contribute each year in two ways:

1, An annual $200 contribution per family to the Help Us Grow (HUG) building fund, AND

2. A yearly $150 Family Commitment Fee for the general maintenance costs, which can be satisfied in cash, or 10 hours of volunteer time to authorized service projects.

By selecting "I Agree", you agree to satisfy the requirements for the HUG and FCF.

Do you agree?*

Parent/Guardian Signature*

LIBRARY PERMISSION

Click here for Library Permission and use information

I give permission for my child listed in this profile to check out books from the library this school year.
I have read and understand the procedures and fees for lost, missing, or damaged library materials.

Do you agree?*

Parent/Guardian Signature*

TECHNOLOGY INFORMATION AND PERMISSIONS

Click here for Student Acceptable Use Policy. I agree as part of my contractual] agreement with First Lutheran to abide by all the policies and procedures set forth in the Student Acceptable Use Policy and that | will be invoiced $100 for tech fee (grades 5-8) on my August Smart Tuition Account. I also acknowledge that the First Lutheran School Administration May amend any and all policies as deemed necessary for the Safety and education of Our students.

Do you agree?*

Parent/Guardian Signature*

Click here for information regarding our G Suite for Education Privacy and Security Information and here for our G Suite for Education Parent Permission Form. If you decide to deny your child permission to access G Suite for Education, please submit a written request to Mrs. Tammy Kirkpatrick for your child to opt-out of G Suite for Education. You will need to discuss with your child’s teachers any necessary accommodations that must be made in order for your child to complete assignments and receive communication from teacher and fellow students.

Do you agree?*

Parent/Guardian Signature*

Select Number of Parents/guardians*

Parent 1 Information

Name of Parent 1*

First NameMiddle NameLast Name

Email*

example@example.com

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary parent to contact in case of an emergency

Phone Number*

Marital Status

Employer*

Employer City

Occupation

Work Phone Number

Employer City*

Highest Level of education attained:

I am a graduate of First Lutheran School

Religion Preference:

Are you a member of First Lutheran Church?

Volunteering

Occupation

Are you interested in being a room parent?

If you are willing to help with translations, languages you speak:

Parent 2 Information

Name of Parent 2*

PrefixFirst NameMiddle NameLast NameSuffix

Primary parent to contact in case of an emergency

Email*

example@example.com

Marital Status

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Employer*

Employer City

Occupation

Work Phone Number

Highest Level of education attained:

I am a graduate of First Lutheran School

Religion Preference:

Are you a member of First Lutheran Church?

Volunteering

Are you interested in being a room parent?

If you are willing to help with translations, languages you speak:

Parent 3 Information

Name of Parent 3*

PrefixFirst NameMiddle NameLast NameSuffix

Primary parent to contact in case of an emergency

Email*

example@example.com

Marital Status

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Employer*

Employer City

Occupation

Work Phone Number

Highest Level of education attained:

I am a graduate of First Lutheran School

Religion Preference:

Are you a member of First Lutheran Church?

Volunteering

Are you interested in being a room parent?

If you are willing to help with translations, languages you speak:

Parent 4 Information

Name of Parent 4*

PrefixFirst NameMiddle NameLast NameSuffix

Primary parent to contact in case of an emergency

Email*

example@example.com

Marital Status

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Employer*

Employer City

Occupation

Work Phone Number

Highest Level of education attained:

I am a graduate of First Lutheran School

Religion Preference:

Are you a member of First Lutheran Church?

Volunteering

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