JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Preschool/Childcare Registration
Please fill out and we will contact you about availability. We will also require a $60 registration fee to hold your spot.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Childs Name (First, Middle, Last)
*
Your answer
Name child prefers to be called.
*
Your answer
Child's Address
*
Your answer
Child's Gender
*
Male
Female
Child's Date of Birth
*
MM
/
DD
/
YYYY
List any existing medical conditions, allergies, medications and/or special attention your child may require:
*
Your answer
Church Attending
Your answer
Please check the Program you child will be attending.
*
Infant/Toddler
Before/Aftercare
Preschool
K-Club
Required
Days child will be attending.
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Guardian #1 First and Last Name
Your answer
Please mark if Guardian #1 is Custodial Parent
*
Yes
No
Guardian #1 Address
*
Your answer
Guardian #1 Phone Number
*
Your answer
Guardian #1 Email
*
Your answer
Mother/Guardian Marital Status
Married
Divorced
Seperated
Widowed
Clear selection
Guardian #2 First and Last Name
Your answer
Please Mark if Guardian #2 is Custodial Parent
Yes
No
Clear selection
Guardian #2 Address
Your answer
Guardian #2 Phone Number
Your answer
Guardian #2 Email
Your answer
Guardian #2 Martial Status
Married
Divorced
Seperated
Widowed
Clear selection
I agree to pay my child tuition in full by the end of the current school year.
*
I agree
I disagree
How did you hear about us?
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of St John's Lutheran School.
Report Abuse
Forms
