REGISTRATION 2019-2020 | Messiah Lutheran Church

Preschool Online Registration

We are thrilled to have your child(ren) in Preschool with us this year!

Please complete the information to register your child for the 2019-2020 School Year.
If a question that is required does not apply to you please simply type “None”.

A $50 non refundable registration fee is due to make the application/registration complete.
Please make checks out to Messiah Preschool.
Messiah Preschool NOW accepts Visa & MasterCard payments.
If you would like to pay your registration fee with a Visa or MasterCard, please indicate that in the comments, questions or concerns box at the bottom of the form.

Child's Name*
First Last
Child's Nickname
Child's Date of Birth*
Date Format: MM slash DD slash YYYY
Is Your Child Baptized?*
- Yes
- No
Baptism Birthday
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Primary Email*
Secondary Email
Mother's Name*
First Middle Last
Mother's Cell Phone Number*
Mother's Work Phone Number
Father's Name*
First Middle 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
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 Address Line 2 City State / Province / Region ZIP / Postal 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 Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Number of Emergency Contact #2*
Will your child(ren) be attending daycare before or after school?*
- Yes
- No
Name, Address and Phone Number for your daycare provider
This information will provide them with the permission to pick up your child(ren) from preschool.
Child's Physician's Name, Location & Phone Number*
Dentist's Name, Location & Phone Number*
Church Membership & Location*
If you do not have a church home please write NONE
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
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 promotional purposes, which would include but not limited to their website, brochures, marketing kits, etc. I understand and acknowledge that if my child's photograph is used no named or other identifying information will be used.*
- Yes
- No
Messiah Preschool has my permission to use my child's name, parent/guardian's first names, address, phone number and email address for a class directory that is distributed to classmates during the school year.*
- Yes
- No
How did you hear about Messiah Preschool?*
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 $50.00 is required to make this application/registration complete. This fee is not refundable nor does it apply to tuition. Payments can be made in the form of checks, money orders, Visa or MasterCard. If you would like to pay with a Visa or MasterCard please allow 5 business days to process your registration. Make a note in the comment section and our Director will give you a call!