Enrollment Form
Trinity Lutheran School does not discriminate on the basis of race, color, national or ethnic origin in the administration of its educational policies, admissions policies or other school administered programs.
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Email *
Student's name (Last, First, Middle) *
Gender *
Ethnic origin
Address including City, Zipcode *
County *
Required
Public School District *
Grade *
Date of Birth *
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Date of Baptism
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Home Church & Denomination
Father's name *
Mother's  name *
Father's Address if different from child *
Mother's Address if different from child *
Father's phone  numbers: designate home, work and/or cell *
Mother's phone  numbers: designate home, work and/or cell *
Father's email address
Mother's email address
Marital status
Emergency Contact #1 (Include name, phone number, and relationship to the child) *
Emergency Contact #2 (Include name, phone number, and relationship to the child)
Emergency Contact #3 (Include name, phone number, and relationship to the child)
Authorized Pick Up List (First and Last Name) *
Health insurance information (please include insurance company and policy number)
Please list any allergies/health conditions and any medication that your child takes regularly.   *
Doctor : name and phone number
I certify that the information contained on this enrollment form is true and accurate as of this date *
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This form was completed by *
Required
There is a $100.00 non-refundable deposit due at the time of registration which will be deducted from the balance of your tuition bill.
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