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St. Peter's Lutheran Church Nursery School Registration
4897 Old Oneida Road
Verona, NY 13478
(315) 363-5211
nurseryschool@stpetersverona.org
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Email
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Your email
Child's Full Name
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Gender
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Home Address
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Your answer
Date of Birth
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MM
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DD
/
YYYY
Mailing Address (if different from home address)
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Home or Cell Phone Number
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Alternate Phone Number
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Parent / Guardian 1 Full Name
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Your answer
Parent / Guardian 1 Employer
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Parent / Guardian 1 Work Phone
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Parent / Guardian 2 Full Name
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Parent / Guardian 2 Employer
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Parent / Guardian 2 Work Phone
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Emergency Contact 1
Name, Phone Number, Relationship to Child
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Your answer
Emergency Contact 2
Name, Phone Number, Relationship to Child
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Siblings
Names and Ages
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Child's Physician and Phone Number
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Any known allergies
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Physical concerns
speech delays, coordination, etc.
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Child's fears
bugs, thunder, separation anxiety, loud noises, etc.
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How does your child get along with other children?
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Additional comments/concerns regarding your child
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I understand that tuition is $150 each month from September to May, typically due the first of each month.
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Agreed
I understand that my child must be 3 years old by December 1 of this school year and toilet trained.
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Agreed
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