School Application Form

School Application Form

Lamb of God Lutheran Preschool

Use this form to collect all required information for student's enrollment.
Student Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Place of Birth
Gender

MaleFemale
Phone Number
Please enter a valid phone number.
Parent's Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Level
School Year
Parent/Guardian's Information
Parent/Guardian's Name - Primary

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.
Parent/Guardian's Name - Secondary

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.
I authorize the child care operation to release my child to leave the child care operation ONLY whith the following persons. Please list name and telephone number for each. Children will only be released to a parent or gaurdian or to a person designated by the parent/gaurdian after verification of ID.
Authorized Release Person

First NameLast Name
Authorized Release Person

First NameLast Name
Phone Number
Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Relationship
Please enter a valid phone number.
Relationship
Please enter a valid phone number.
File Upload

ID Picture of parent/guardian, student's birth certificate, and most current shot records
Upload
Health History
If the student have any allergies, please list them down below:
Does the student currently taking any medications? If yes, please list them down below:
Was the student previously hospitalized or undergo any surgery?
Does the student have any medical conditions that you would like to declare?

Immunization/Vaccination

	Vaccinated?	Year
Hepatitis B
Rotavirus
Diphtheria
Tetanus
Pertussis
Hemophilus Influenza Type B
Pneumococal
Inactivated Poliovirus
Influenza
Measles, Mumps, Rubella
Varicella
Hepatitis A

In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to: Physician and Emergency Medical Facility Information
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I give consent for my child to be transported and supervised by the operation's employees.
Field Trips: Do your children have permission to participate in field trips?
Reminders
TEST. The school required new students or a transferee to take an exam in order to get admitted to the school.

INTERVIEW. The school admin will conduct an interview with the student as part of the screening test.

REQUIREMENTS. It is important to pass and complete all requirements before school starts. Failure to do so may delay the student from coming to school.

MEDICAL CLEARANCE. The school required all students to have a yearly physical exam. For new students, medical clearance for their doctor or school doctor is required.

BEHAVIOR. A certificate of good moral is required in order to get admitted to this school. Please request it from the previous school as soon as possible.
Date Signed

MonthDayYear
Date
Parent/Guardian Signature

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School Application Form

Parent/Guardian's Information

File Upload

Health History

Reminders