St. Luke's Preschool & Kindergarten 2025-2026 Registration
Child's Information
Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
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Month
Please select a day
1
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Day
Please select a year
2026
2025
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2023
2022
2021
2020
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2015
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2012
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Year
Age on September 1, 2025
Gender
*
Female
Male
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Best Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child lives with:
*
Both parents
Mother only
Father only
Other
Family Information
Father or Guardian Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address if different than child:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
example@example.com
Place of Work
Mother or Guardian Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address if different than child:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Family Email Address
*
example@example.com
Place of Work
Name of Church
Emergency Contact Name
*
First Name
Last Name
Relationship to child
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
First Name
Last Name
Relationship to child
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
My emergency contacts are also authorized to pick up my child
*
Yes
No
Name Relationship to Child Phone Number
Relationship
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Information
Doctor's Name
*
First Name
Last Name
Doctor's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred hospital
*
I give consent for the facility to secure any and all necessary emergency medical care for my child.
*
Siblings and their ages
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns. If none, please type none.
*
List any developmental concerns or needs and any services your child is receiving such as speech or OT.
My child is completely toilet trained
*
Please Select
Yes
No
Will be by the first day of school
Must be completely toilet trained by the first day of school to attend.
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I understand and will comply with the financial policies of St. Luke's Preschool & Kindergarten
*
Please Select
Yes
No
I acknowledge receipt of "St. Luke's operational policies".
*
Please Select
Yes
No
Operational Policies
I grant permission for my child to use all of the play equipment & participate in all of the activities at the school.
*
Please Select
Yes
No
I grant permission for my child to be included in internal use pictures and videos.
*
Please Select
Yes
No
I grant permission for my child to be included in pictures and videos posted on the school's social media.
*
Please Select
Yes
No
For the current school year my child is:
Enrolled in St. Luke's Preschool
Enrolled in St. Luke's PDO
I am a member of St. Luke's Church
None of the above
I would like my child to be enrolled in: (PreK classes are 9:00-12:00; Kindergarten is 8:45-12:00)
*
PreK 3 Tuesday/Thursday
PreK 3 Monday/ Wednesday/ Friday (Full-join wait list)
PreK 3 Monday-Friday (Full- join wait list)
PreK 4 Tuesday/ Thursday
PreK 4 Monday/Wednesday/Friday
PreK 4 Monday-Friday (Full- join wait list)
Kindergarten Monday-Friday (Full- join wait list)
Add extended day Tuesday/Thursday (12:00-2:45)
Students can join the wait-listed class and register for a second choice class that is not full by checking both boxes above.
Any notes for the director can be written above.
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