Student-Application-Form 2026-2027

Pick-Up Authorizations and Emergency Conditions
Student Full Name
Grade
Date

MonthDayYear
Date
After School Routine

List names of all individuals authorized to pick up your child - if additional inputs needed, please work with our office to get them added to your form.
Name & Relationship
Phone Number
Please enter a valid phone number.
Name & Relationship
Phone Number
Please enter a valid phone number.
Name & Relationship
Phone Number
Please enter a valid phone number.
Name & Relationship
Phone Number
Please enter a valid phone number.
Emergency Medical Authorization
I hereby give permission for emergency medical treatment for First Name Last Name if requested by BLS & ELC, who are our providers of childcare.
Does your child have a history of reactions to food or other allergens?

YesNo
If yes, please explain what Plan of Treatment is to be used for your child in case of sign of allergic reaction.
Please note my child is allergic to the following medications:
List all known allergies
It is also important to note that my child has the following special medical conditions:
Are there medications which your child will have to be given at school? If so, he/she will need a medication authorization filled out and given to the school to be kept in his/her permanent file.

YesNo
Medications:
Physician's Full Name
Physician's Phone Number
Please enter a valid phone number.
Alternative Emergency Contact Name
Phone Number
Please enter a valid phone number.
Signature
Date

MonthDayYear
Date

Permission Forms
Student's Name
Parent/Guardian's Name

First NameLast Name
Check the following:

I hereby certify the information on this application is accurate and complete. I understand that inaccurate or incomplete information may result in non-acceptance or dismissal from school.I affirm that I have reviewed the Bethesda Lutheran School Handbook or the ELC Handbook, and I agree to comply with all policies and conditions stated within.I also agree to discuss relevant information from the Handbook with my child.
Do you give permission for your child's image in a photograph/video be shared/published on the school's website, in the local newspaper and/or school brochures, in the LCMS Synod publications or on social media?

Yes, I give permissionNo, I do not give permission for my child's image to be published
Signature
Date

MonthDayYear
Date
School Session Applying for:
Should be Empty:

School Registration Form 2026-27