Preschool Registration 2023 | Messiah Lutheran Church

Which class are you registering for?
Request to be in the same class as (list student name):
We cannot guarantee this request but will try to honor it if possible.

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About Your Child
Student's Full Name
First Middle Last
Name Student Prefers
First
Date of Birth
Gender
T-Shirt Size
Other Size:
Child's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Primary Contact Email Address
Note: We will send a copy of this application to this email address.
Home Phone
Is your child baptized?
- Yes
- No
Date of Baptism
Church/Place of Baptism
Does your child have any previous school experience?
Are there any custodial issues we should be aware of?

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About Your Family
Parental Status
Check all that apply.
- Married
- Separated
- Divorced
- Single Parent
- Father Remarried
- Mother Remarried
- Father Deceased
- Mother Deceased
MOTHER/GUARDIAN INFORMATION
Mother/Guardian Name
First Last
Does the child's mother/guardian reside at the same address listed above?
- Yes
- No
Mother's Address
Street Address Address Line 2 City State ZIP Code
Mother's Home Phone
Mother's Cell Phone
Should we text this cell phone?
- Yes
- No
Mother's Employer
Mother's Work Phone
FATHER/GUARDIAN INFORMATION
Father/Guardian Name
First Last
Does the child's father/guardian reside at the same address listed above?
- Yes
- No
Father's Address
Street Address Address Line 2 City State ZIP Code
Father's Home Phone
Father's Cell Phone
Should we text this cell phone?
- Yes
- No
Father's Employer
Father's Work Phone
Are there any other children in your family?
Use the plus sign to add more than one child.
Name Date of Birth Relationship

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Transportation Authorization
Authorized Transportation
Your child will be allowed to leave ONLY with a parent/guardian or those listed below. Use the plus sign to add more than one contact.
Name Phone Number Relationship

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Agreement
Checking the box below indicates your agreement to the following:*
I/we understand this application cannot be processed without the application fee, copy of immunization record, and copy of the birth certificate.

I/we understand that all children accepted are subject to a 30 day trial basis.

I/we understand that parents must attend the scheduled parent/teacher meetings.

I/we understand that I/we may be asked to withdraw my child from school if tuition becomes past due.

I/we understand that my child’s photo image may be used for advertising purposes.

I/we have read, understand, and agree to the policies in Messiah’s Children Preschool handbook.

I/we agree to comply with school policies as set forth by Messiah’s Children Preschool and presented in the Preschool handbook.

I/we agree to give my child permission to take part in all school activities.

I/we agree to pick up my child from school upon request in case of illness, discipline or bathroom issues.
We, as parent(s)/guardian(s) of the student applicant, verify that this information is true and accurate.

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Financial Agreement
Please visit our Fees + Tuition page for more information about our application fees, tuition and payment schedules.
Name of person financially responsible for student:
First Last
Address (if different from student)
Street Address Address Line 2 City State ZIP Code
What payment plan would you like?*
- Early Bird Full Payment (Enrolled before June 1st; 5% discount if paid by September 1)
- Monthly Payments (First & last months due September 1)
Tuition Agreement*
Messiah’s Children Preschool does not wish to turn away any student due to tuition issues.

Parents are encouraged to communicate in writing, if problems or difficulties arise with this financial agreement. All inquires will be considered.

All Tuition policies are outlined in Messiah’s Children Preschool Handbook.
We have read the stated Tuition Policies and agree to them.

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Medical Information
Does your child have any of the following conditions?
- Allergies
- Dietary Regulations
- Asthma
What types of allergies does your child have?
What types of dietary regulations does your child have?
Please list allergens:
Does your child require any prescribed medication?
- Yes
- No
If so, you are required to provide the Preschool with a written protocol created by your child's doctor describing appropriate treatment for conditions listed above.
Physician's Name
Physician's Phone Number
Dentist's Name
Dentist's Phone Number
Emergency Contacts
In the event of emergency, who can we notify other than the parents? Use the plus sign to add multiple contacts.
Name Phone
Are the emergency contacts listed above on the transportation list?
- Yes
- No
Is there any additional medical or physical information you would like to disclose about your child?
Emergency Consent*
In the event of an emergency, Messiah’s Children Preschool has my permission to administer first aid or obtain emergency medical treatment in my child’s best interest. I also agree to pay all expenses incurred due to an emergency involving my child.
I agree.
Medical Agreement*
I certify this information is correct to the best of my knowledge.
Phone
This field is for validation purposes and should be left unchanged.

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Preschool Registration
2023-2024

Registration Fees + Schedules

3K Class

4K Class

Messiah's Children Preschool Application

Preschool Registration Form 2023

Step 1 of 8

About Your Child

About Your Family

MOTHER/GUARDIAN INFORMATION

FATHER/GUARDIAN INFORMATION

Transportation Authorization

Miscellaneous

Agreement

Financial Agreement

Medical Information

Service Times

Contact Us

About Us

Name	Date of Birth	Relationship

Name	Phone Number	Relationship

Name	Phone

Preschool Registration2023-2024

Registration Fees + Schedules

3K Class

4K Class

Messiah's Children Preschool Application

Preschool Registration Form 2023

Step 1 of 8

About Your Child

About Your Family

MOTHER/GUARDIAN INFORMATION

FATHER/GUARDIAN INFORMATION

Transportation Authorization

Miscellaneous

Agreement

Financial Agreement

Medical Information

Service Times

Contact Us

About Us

Preschool Registration
2023-2024