REGISTRATION FORM ACADEMIC YEAR 2019-2020

Age determined by age of child on Aug. 1, 2019.

(Scholarships available upon request.)

                     ____ 2 year-old Caterpillar Class (Tues & Thurs 8:30-11:30) ($90)

                       ____ 2/3 year-old Butterfly Class (Mon & Wed 8:30-11:30) ($90)

                       ____ 3/4 year-old Scouts Class (Mon-Wed 8:30-11:30) ($125)

               ____ 4/5 year-old Pre-K Explorers Class (Mon-Thurs 8:30-11:30)($165)(Mon-Fri 8:30-11:30)($195)

 ____ Sarah’s Stars Friday enrichment focused on the arts (This program is for children age 3-Pre-K.  This class meets every Friday from 8:30-2:00. The cost is $35 a month. This class may be in addition to enrollment in another class.)

Child’s Name: ____________________________________Nickname: ____________________________

____ Female   ____ Male   DOB:  ___________________ Home Phone: __________________________

Home Address:  __________________________________________________________________________

City, State, Zip: ___________________________________________________________________________

Mother’s Name: __________________________________ Occupation:  _________________________

Bus. Phone:  __________________ Cell Phone:  ___________________   Email: ____________________

Father’s  Name:  _________________________________ Occupation:  __________________________

Bus. Phone:  __________________ Cell Phone:  ___________________   Email: ____________________

Guardian (if different than above):  _______________________________________________________

Do you currently have a home church?  ____ yes ____ no   If yes, please list _________________

Sibling Information:

Name:  _________________________   Age: _____ Name:  _________________________   Age: _____

Name:  _________________________   Age: _____ Name:  _________________________   Age: _____

Allergies (food, insects, etc.): _____________________________________________________________

Health issues (asthma, etc.): ______________________________________________________________

A NON-REFUNDABLE ENROLLMENT FEE OF $50 IS DUE UPON REGISTRATION

Parents Signature: ____________________________________________   Date: ____________________

PLEASE MAIL OR RETURN COMPLETED APPLICATION TO:

Trinity Lutheran Church Preschool   1801 N. Main St Auburn, IN 46706    260.925.6544

TLC PRESCHOOL AUTHORIZATION AND CONSENT FORM

Child’s name:  _______________________________________ Date of Birth:  ______________________

I authorize the TLC Preschool teachers who are trained in First Aid to give my child first aid when appropriate.  

I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child.  However, if I cannot be reached, I hereby authorize the TLC Preschool or Emergency Medical Response personnel to transport my child to the nearest medical facility for necessary medical treatment for my child.

Child’s Physician’s name:  ________________________________________________________________

Address:  _____________________________________ Phone Number: ___________________________

Emergency Contacts (In order to be contacted after contacting parents)

  1. Name:  ______________________________________ Address:______________________________________

Relationship to child:  __________________________ Phone #:  __________________________

Do you give permission for child to be released to this person?  Yes ______    No _______

  1. Name:  ______________________________________  Address:______________________________________

Relationship to child:  __________________________ Phone #:  __________________________

Do you give permission for child to be released to this person?  Yes ______    No _______

  1. Name:  ______________________________________  Address:______________________________________

Relationship to child:  __________________________ Phone #:  __________________________

Do you give permission for child to be released to this person?  Yes ______    No _______

Date:  __________________   Parent Signature:  ______________________________________________

TLC PRESCHOOL ON-PROPERTY PERMISSION SLIP

I give permission for my child, ________________________________, to explore and go for walks and nature hikes on school property with the TLC Preschool staff.  

Date:  ___________________ Parent Signature:  ______________________________________________

PUBLICITY RELEASE

I give permission for my child’s picture to be released for publicity purposes through the church newsletter, local newspaper, and social media.

Date:  __________________ Parent Signature:  _______________________________________________