2026-2027 APPLICATION FORM

2026-2027 APPLICATION FORM
**A separate application form and contract are required for each child you are enrolling**
ENROLLMENT DETAILS
Non-Refundable $400 Enrollment Fee

PLEASE NOTE: This fee no longer applies towards tuition
Bill my FACTS Account
Requires $150 Application Fee & Non-Refundable $400 Enrollment Fee - PLEASE NOTE: These fees do not apply toward tuition
PROGRAM SELECTION

(Students entering 3's class and above must be fully potty trained)
Click on a Program to Select
ADD TO WAITLIST
SPECIFY DESIRED DAYS
SPECIFY DESIRED DAYS
SPECIFY DESIRED SCHEDULE
STUDENT INFORMATION
Child's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Birthdate

MonthDayYear
Date
Gender
Child lives with:

Other (Grandfather, Aunt, etc.)
Primary Language Spoken at Home:
English, Spanish, Chinese, etc.
Ethnicity
Race/Ethnicity

Other
FAMILY INFORMATION
Parent/Guardian #1

First NameLast Name
Relationship

Other (Grandfather, Aunt, etc.)
Address (if different from above)

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Parent/Guardian #2

First NameLast Name
Relationship

Other (Grandfather, Aunt, etc.)
Address (if different from above)

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Sibling(s)
Name
Age
Name
Age
Name
Age
Allergy / Medical Information
My child has an allergy/medical condition
Please specify the allergy or medical condition
Preferred Hospital in case of an Emergency
PEOPLE AUTHORIZED TO PICK UP MY CHILD

We need at least ONE person other than the parents to be listed as an emergency contact
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
(Grandfather, Aunt, Friend, etc.)
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
(Grandfather, Aunt, Friend, etc.)
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
(Grandfather, Aunt, Friend, etc.)
Permission Statements
I hereby give permission for my child to be photographed and/or video taped at St. Timothy's Christian Preschool or on a school trip. I understand that these pictures could be used in school projects, newsletters, social media, brochures, and/or possible advertising.
I give permission to have my name, address, phone number and email in the school directory
Parent Signature
Student Survey
My child is an active member of St. Timothy's Lutheran Church
Digital Signature
We, as parents, understand that quality education requires the joint effort of home and school. As a result, we will be supportive of the programs and policies of the school in order to strengthen our child's Christian education.
An authorized representative or licensing analyst from the Department of Social Services/Community Care Licensing may, upon presentation of proper identification, enter and inspect the preschool at any time with or without prior notice. The DSS/CCL has the authority to interview children and staff without prior consent.
Parent Name

First NameLast Name
Date

MonthDayYear
Date
Parent Signature
***PLEASE CLICK SUBMIT BUTTON. YOU WILL BE REDIRECTED TO THE CONTRACT TO MOVE FORWARD WITH THE APPLICATION PROCESS***
Should be Empty:

2026-2027 APPLICATION FORM

**A separate application form and contract are required for each child you are enrolling**

Non-Refundable $400 Enrollment Fee

PROGRAM SELECTION

STUDENT INFORMATION

FAMILY INFORMATION

Allergy / Medical Information

PEOPLE AUTHORIZED TO PICK UP MY CHILD

Permission Statements

Student Survey

Digital Signature

***PLEASE CLICK SUBMIT BUTTON. YOU WILL BE REDIRECTED TO THE CONTRACT TO MOVE FORWARD WITH THE APPLICATION PROCESS***

A separate application form and contract are required for each child you are enrolling

PLEASE CLICK SUBMIT BUTTON. YOU WILL BE REDIRECTED TO THE CONTRACT TO MOVE FORWARD WITH THE APPLICATION PROCESS