Pre-Register Page - Messiah Lutheran Church & Preschool

Thank you for being a part of the Messiah Preschool family!

Preschool Registration 2022-2023

Child's Information
Child's Name*
First Last
Child's Nickname
Child's Date of Birth*
MM slash DD slash YYYY
Is Your Child Baptized?*
- Yes
- No
Baptism Birthday
MM slash DD slash YYYY
Has your child been dedicated?*
- Yes
- No
- Unsure
Dedication Date
MM slash DD slash YYYY
This child will attend Kindergarten starting in September of:*
- 2023
- 2024
- 2025
Family Information
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Primary Email*
Secondary Email - if different than the primary
Mother's Name*
First Last
Mother's Occupation*
Mother's Cell Phone Number*
Mother's Work Phone Number
Father's Name*
First Last
Father's Occupation*
Father's Cell Phone Number*
Father's Work Phone Number
Living Situation*
Please describe your child(ren)'s current living situation (example: Carter lives at home with both parents, sister and brother. OR Carter lives with mom & step-dad during the week, dad on weekends). Include any children in the household and their ages
Does your child have any previous group expereinces?*
- Yes
- No
Please describe any group experiences your child has had in the past.
Church Membership & Location*
If you do not have a church home, please write NONE
Emergency Contact Information
Name of Emergency Contact #1 (cannot be a parent)*
In the event of an emergency and the parent's are unable to be reached, please list TWO (2) people, WHO ARE NOT PARENTS, who should be contacted. Please be sure that these people have permission to transport your child. The following list will be considered permission from you to have these people pick up your child from preschool. **THE INDIVIDUALS CANNOT BE PARENTS, PLEASE LIST 2 ADULTS WHO ARE NOT PARENTS.
First Last
Relationship to Child*
Address of Emergency Contact #1*
Street Address City State ZIP Code
Phone Number of Emergency Contact #1*
Name of Emergency Contact #2 (Cannot be a parent)*
First Last
Relationship to Child*
Address of Emergency Contact #2*
Street Address City State ZIP Code
Phone Number of Emergency Contact #2*
Other Contact Information
Child's Primary Physician or Clinic Name*
Physician's Address*
Street Address City State ZIP Code
Physician's Phone Number*
Child's Dentist or Clinic Name*
If your child does not have a Dentist, please write in YOUR dental clinic information - if you have no dental affiliation please select a dental clinic in your area. This information is mandatory for the State of Minnesota
Dentist's Address*
Street Address Address Line 2 City State ZIP Code
Dentist's Phone Number*
Select Class and Aftercare Options
Class Options:
Monday - Friday
Half Day (9am - 11:30am)
Full Day (9am - 3:30pm)

Extended Days (7:30am - 9am) &/or (3:30pm - 5:30pm)
Typical Classes Are:
Monday/Wednesday/Friday
Tuesday/Thursday
Monday/Tuesday/Wednesday/Thursday/Friday

A minimum of 2 days per week is required for registration.

Enrollment into a classroom is based upon the child's date of birth. Upon review, the director has the authority to place a child into a classroom that the teaching staff and director feels is appropriate. A review of all applications will occur prior to the school year and should a discrepancy be noted parents will be contacted.

Each class session has a minimum enrollment of 8 and a maximum enrollment of 15 in our Preschool (3/4 year olds) classroom & 20 in our PreKinders (4/5 year olds) classroom.
HALF DAY PROGRAM days of the week selection
- Monday, Wednesday & Friday
- Monday & Wednesday
- Tuesday & Thursday
- Monday, Tuesday, Wednesday, Thursday & Friday
- Other, describe in detail in comments - must have Director's approval
FULL DAY PROGRAM days of the week selection
- Monday, Wednesday & Friday
- Monday & Wednesday
- Tuesday & Thursday
- Monday, Tuesday, Wednesday, Thursday & Friday
- Other, describe in detail in comments - must have Director's approval
Will you be using our extended care program?*
- Yes
- No
Select the day(s) and time(s) that Extended Care is needed
- Select All
- Monday, AM
- Monday, PM
- Tuesday, AM
- Tuesday, PM
- Wednesday, AM
- Wednesday, PM
- Thursday, AM
- Thursday, PM
- Friday, AM
- Friday, PM
Other Information
Does your child have any food allergies or dietary restrictions we need to know about?*
- Yes
- No
Please describe the allergy and dietary restriction
Messiah Preschool has permission to TAKE photographs of my child. (including class pictures, individual photos, professional photos etc.)*
- Yes
- No
Messiah Preschool has permission to use my child's photos for general purposes such as bulletin boards, website, Brightwheel, program slide shows, church videos, brochures and other promotional items. I understand and acknowledge that if my child's photograph is used, no names or other identifying information will be included.*
- Yes
- No
Messiah Preschool has permission to include my child's information into a family directory that is only available to other Messiah Preschool families.*
- Yes
- No
How did you hear about Messiah Preschool?*
Why did you choose Messiah Preschool for your child?*
Did a current Messiah Preschool family refer you to us? Please let us know who they are so that we can thank them! (full name)
Comments, Questions or Concerns... write them here!
A registration fee of $75.00 is required to make this application/registration complete. This fee is not refundable nor does it apply to tuition. You will receive an invoice from our Preschool office through Brightwheel within 15 business days. This invoice will be due within 30 days of receipt. Through Brightwheel you will be able to use a checking/savings account or credit card to pay the registration fee. Any questions can be directed to our Preschool Director, Annie Bilski.

CONTACT

Thank you for being a part of the Messiah Preschool family!

Preschool Registration 2022-2023

Child's Information

Family Information

Emergency Contact Information

Other Contact Information

Select Class and Aftercare Options

Other Information