Preschool Student Enrollment Form
Please fill out all of the form below to the best of your knowledge.
Child's Full Name
*
First Name
Last Name
Child's Age
*
Please select your child's age
Child's Date of Birth
*
/
Month
/
Day
Year
Please select your child's date of birth
Child's Sex
*
Male
Female
How would you describe your child?
*
Native American/Alaskan Native
Afro-American
Hispanic
Asian
Caucasian
Other
What class are you enrolling for?
What is your church affiliation, if any?
Notice of Non-Discrimination: Our Savior's Preschool prohibits discrimination on the basis of race, sex, religion, color, creed nation or ethnic origin. This preschool is required to report on the racial composition of it's students to the government. Self-identification is voluntary.
Back
Next
Save & Continue Later
Primary Parent/Guardian Information
Primary Parent/Guardian Name
*
First Name
Last Name
Marital Status
*
Single
Married
Divorced
Widower
Other
Primary Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
Please enter a valid phone number.
Primary Email
*
example@example.com
Job & Company/Employer
*
Company/Employer Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Work Phone Number
*
Please enter a valid phone number.
Instructions on how to find parent/guardian during preschool hours.
*
How did you hear about OSLP?
*
Back
Next
Save & Continue Later
Emergency Contacts
Please provide 3 adult contacts OTHER THAN THE PRIMARY PARENT/GUARDIAN who are able to help in the event of an emergency.
Emergency Contact 1
*
First Name
Last Name
Emergency Contact 1 Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Emergency Contact 1 Phone
*
Please enter a valid phone number.
Emergency Contact 2
*
First Name
Last Name
Emergency Contact 2 Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Emergency Contact 2 Phone
*
Please enter a valid phone number.
Emergency Contact 3
*
First Name
Last Name
Emergency Contact 3 Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Emergency Contact 3 Phone
*
Please enter a valid phone number.
Back
Next
Save & Continue Later
NONE Parent/Guardian Authorized Pick Up
Please List up to 4 additional people who you give permission to pick- up your student.
Authorized Person #1
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Name
First Name
Last Name
Authorized Person #2
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Authorized Person #3
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Authorized Person #4
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Back
Next
Save & Continue Later
Medical Information
Medical Insurance
*
Medical Insurance Policy Number
*
Copy of your Medical Insurance
*
Browse Files
Drag and drop files here
Choose a file
If you are able, please upload a copy of your insurance card
Cancel
of
Child's Medical Provider
First Name
Last Name
Medical Provider address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Medical Provider Phone
*
Please enter a valid phone number.
Child's Dentist
*
First Name
Last Name
Dentist Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Dentist Phone
*
Please enter a valid phone number.
Hospital of Choice
*
Please Select
NCMC- Northern Colorado Medical Center
UH Greeley Hospital
MCR- Medical Center of the Rockies
In the event of an emergency which hospital would you like us to try and go to?
Does your child have any allergies, dietary needs or physical/learning limitations?
Back
Next
Save & Continue Later
Medical Statement of Health
Please download this form and have your Healthcare Provider fill it out and submit it here or email it to the preschool at preschooloursaviors@gmail.com
Statement of Health
Upload Medical Forms (Statement of Health & Immunization Record or Completed Exemption form
Browse Files
Drag and drop files here
Choose a file
Cancel
of
We are required to have a health form signed and dated by a health care provider as well as an up to date immunization record or completed exemption form every year. do you agree to having both returned to Our Savior's Lutheran Preschool before the child can start school.
*
I understand and agree to the above.
Back
Next
Save & Continue Later
School Experience
What would you like for your child's preschool experience?
*
Where will your child be attending Kindergarten
*
Have other children in your family attended Preschool?
*
Yes
No
Other
Social & Emotional Experience
Does your child attend daycare?
*
Yes
No
If yes, Where & How often?
Does your child participate in other group settings?
*
Yes
No
Will your child be able to freely participate in all activities inside/outside the classroom?
*
Yes
No
Does your child have any nervous habits?
*
Briefly describe your child's personality
*
Do you have any concerns about your child attending preschool?
*
Toilet Habits
Your child MUST be completely toilet trained before attending OSLP, with the ability to use the facility and wash their hands with little adult aid.
Toilet Habits Agreement
*
I agree to the above statement and my child is fully potty trained.
Please choose all that apply, My child can...
*
Prints Name
Knows Shapes
Uses Sissors
Speaks more than one language
Plays sports/gymnastics/dance
Recognizes Letters
Knows Phone Number
Listens to a story
Recognizes Numbers
Counts to 10
Knows Address
Take Music Lessons
Back
Next
Save & Continue Later
Emergency Authorization
I give my permission to Our Savior's Preschool and Our Savior's Lutheran Church to call a doctor for medical care for my child should an emergency arise. It is understood that the school will call 911 and would make a reasonable effort to locate me. I have listed three(3) emergency references, our physician and our dentist in my child's file. I will accept any expenses regarding my child's medical emergency and care.
*
Field Trip Authorization
I give my permission and consent for my child to take part in field trips or excursions away from the preschool premises weather on foot or by vehicle. I understand that my child will be under the supervision of the preschool staff and other adults that are assisting. I also understand that the preschool will notify me of any planned excursions or field trips. It is my responsibility to read the newsletters/remind notifications regarding this, and contact the school if I do not wish for my child to participate.
*
Media Release
I give consent for my child to view a video under staff supervision. I will contact my child's teacher if I do not wish for my child to participate.
*
General Release Statement
I, as a parent or legal guardian of the child listed above, in consideration for the use of preschool facilities and playground or Our Savior's Preschool and Our Savior's Church, do hereby release and forever discharge Our Savior's preschool and Our Savior's Lutheran Church from any and all matters of action, causes of actions, suits, proceedings, damages, claims and demands whatsoever in law and equity, which I had, now have, or may have in the future as a result of the use of the facilities and grounds. This release is binding on the heirs, executors, administrators, personal representatives, and assigns of the parties hereto.
*
Today's Date
*
/
Month
/
Day
Year
Ple.ase select the date you sign this document
Here you have the option to pay for preschool in full for a discount. This is not a requirement just an option we offer at a 10% Discount.
Tuition Pay-in-full Options (Pay for the whole year and get 10% Off)
prev
next
( X )
TU/TH Class- Year In-Full
(9 payments $135) Beginner classes (3 yrs old) + $40 in supply fees for the year
$
1,130.00
M/W/F AM or M/Tu/W/Th PM Class- Year in Full
$1950.00/year (9 payments $190) Pre-K + $50 in supply fees for the year
$
1,755.00
Back
Next
Save & Continue Later
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Save & Continue Later
Continue
Continue
Should be Empty: