Preschool Registration Form

Preschool Registration Form

Please complete the form below to apply for enrollment in our preschool. Class placement is determined on a first-come, first-served basis, so we encourage you to submit your application early. To be eligible for enrollment in Little Lamb Preschool, children must be between 3 and 5 years old on or before September 1 and fully potty trained.
Class Enrollment

Please Note: The 3 Day Session is our original program, and this class will be filled first. In the event that we have enough students to fill an additional class, we will offer a Tuesday/Thursday class to accommodate the need. Please mark your preference as follows:
1 = First Preference

2 = Second Preference

X - I am NOT INTERESTED in this session at all.
3 Year Old Class

Must be 3 by September 1st and fully potty trained
3 Day Session
Mon/Wed/Fri 8:30 - 11:30 am
2 Day Session
Tues/Thurs. 8:30 am - 12:00 pm
Pre-K (4 Year Old) Class

Must be 4 by September 1st and fully potty trained
3 Day Session
Mon/Wed/Fri 8:30 - 11:30 am
2 Day Session
Tues/Thurs. 8:30 am - 12:00 pm
Child's Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
BoyGirl
Phone Number*
Format: (000) 000-0000.
Email Address*
YesNo
Travel & Activity Authorizaton

I give permission for my child to leave the preschool on trips on foot, in a car, or in a church vehicle on school-sponsored field trips. (All children will be secured in seat belts or car seats.)
YesNo
Media Release

I give consent to let my child be photographed for use by the preschool to be used in our newsletters, displays, and/or the church/preschool website and Facebook Page.
YesNo
Parent/Guardian Information
Name*

First NameLast Name
Relation to Child*
Address (if different than child)

Street Address

Street Address Line 2
CityStateZip Code
Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Local Church Membership*
Employer*
Work Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Name

First NameLast Name
Relation to Child
Address (if different than child)

Street Address

Street Address Line 2

CityState

Zip Code
Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Local Church Membership
Employer
Work Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Information
ParentsMotherFatherStep ParentOther
Please list brothers/sisters and birth date
Authorize Release To:

I hereby give permission for my child/children to leave the preschool with the following persons named. (If no one other than you, the parent/guardians, will be picking up your child/children, please indicate that on this form as well.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child:*
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child:
If there is a separation or divorce custody problem of which we should be aware of, please explain.
Name persons who may NOT pick up the child/children:
Emergency Medical Consent/Information

In the event that student may require medical, surgical, and/or dental/dental surgical care while I am unable to be reached, I herby give my consent to medical, surgical, and/or dental/dental surgical treatment to the following listed medical personnel or his/her designee to provide this care. I agree to pay all costs and fees contingent on any emergency medical care and/or treatment for my child as secured or authorized under this consent.
Name of Family Doctor

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of Dentist

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Hospital:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Known Allergies
Other Health Conditions
Present Medication
Insurance Company
Policy ID Number
Other Information

Please indicate any further information you think we should know such as allergy, disability, handicap, or fears your child may have.
Tuition/Enrollment Fees
3 Days/Week Amount (1 Child) 3 Days/Week Amount (2 Children)

Annually: $1,413 Annually: $2,691

Bi-Annualy: $706.50 Bi-Annualy: $1,346

Monthly: $157 Monthly: $299

2 Days/Week Amount (1 Child)   2 Days/Week Amount (2 Children)

Annually: $1,080   Annually: $2,052

Bi-Annually: $540 Bi-Annually: $1,026

Monthly: $120 Monthly: $228

Little Lamb Preschool offers a 5% sibling discount.

A non-refundable $50 registration fee plus first month tuition must be submitted to the church before application can be considered accepted. *
Signature*

By signing, you acknowledge and agree that students at Little Lamb Preschool are taught in accordance with the doctrines of the Lutheran Church—Missouri Synod (LCMS). You also recognize that our curriculum is Christ-centered and that our program is grounded in the Christian faith and the truth of God’s Word.
By signing above, you confirm that all information provided is complete and accurate. You agree to fulfill all financial obligations and to follow the policies and guidelines of Little Lamb Preschool. Parents/guardians are responsible for notifying the school in writing of any changes to this information. This agreement is valid for one year beginning September 1st of the indicated school year and will remain in effect as long as your child is enrolled.

** Little Lamb Preschool admits students of any race, color, sex, and national or ethnic origin to all the rights, privileges, programs, and activities generally made available to students at the school. We do not discriminate on the basis of race, color, sex, or national or ethnic origin in the administration of our educational policies, admissions policies, financial assistance, or other school programs.
Should be Empty:

Preschool Registration Form

Class Enrollment

3 Year Old Class

Pre-K (4 Year Old) Class

Child's Information

Travel & Activity Authorizaton

Media Release

Parent/Guardian Information

Family Information

Authorize Release To:

Emergency Medical Consent/Information

Other Information

Tuition/Enrollment Fees