REGISTRATION 2019-2020 | Messiah Lutheran Church

Child's Name*

First Last

Child's Nickname

Child's Date of Birth*

Is Your Child Baptized?*

Yes
No

Baptism Birthday

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

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!

Preschool Online Registration