Grace Beginnings Preschool Registration Form
2020-2021 School Year
Email address *
Student Name: *
Your answer
Student Address: *
Your answer
Student Birth Date: *
MM
/
DD
/
YYYY
Desired Class: *
Required
Home Phone: *
Your answer
Mother's Name:
Your answer
Address (if different from students):
Your answer
Mom Cell:
Your answer
Mom Email:
Your answer
Mother's Occupation:
Your answer
Work Phone Number:
Your answer
Father's Name:
Your answer
Dad Cell:
Your answer
Address (if different from students):
Your answer
Occupation:
Your answer
Work Phone Number:
Your answer
Please List Siblings (Names, Ages):
Your answer
Are you interested in more information about Grace Lutheran Church? *
Does your child have any allergies?(If yes, please list)
Your answer
Does your child have any medical conditions we should be aware of? (if yes, please explain)
Your answer
Any additional information we should be aware of?
Your answer
Would you like an invoice emailed to you for the $50.00 (non refundable) registration fee to be paid online with a debit/ credit card? (your child will not be registered until the fee in paid in full) *
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