Trinity Lutheran Preschool

Regristration Form
Child Information:
Child’s Full Name_________________________________________________________
Male ____ Female ____ Date of Birth _______________________________________
Previous Preschool Experience ______________________________________________
Trinity
Lutheran Church Preschool is open to all children regardless of
religious affiliation.
Please complete the following:
____ Attend or a member of Trinity Lutheran Church
____ Attend or a member of ________________________________________________
____ Currently unchurched
Allergies/Food Restrictions/Other Special Needs ________________________________
________________________________________________________________________
Parent/Guardian Information:
Name of Mother__________________________________________________________
Employer _________________________ Home phone number ____________________
Home address ____________________________________________________________
Name of Father___________________________________________________________
Employer __________________________ Home phone number ___________________
Home address ____________________________________________________________
Father Work Phone __________________ Mother Work Phone ____________________
Father Cell Phone __________________ Mother Cell Phone ____________________
Individuals authorized to pick up or receive your child:
(Name) (Relationship)
____________________________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________