Grace Beginnings Preschool Registration Form
2021-2022 School Year
Email *
Student Name: *
Student Address: *
Student Birth Date: *
MM
/
DD
/
YYYY
Desired Class: *
Required
Home Phone: *
Mother's Name:
Address (if different from students):
Mom Cell:
Mom Email:
Mother's Occupation:
Work Phone Number:
Father's Name:
Dad Cell:
Address (if different from students):
Occupation:
Work Phone Number:
Please List Siblings (Names, Ages):
Are you interested in more information about Grace Lutheran Church? *
Does your child have any allergies?(If yes, please list)
Does your child have any medical conditions we should be aware of? (if yes, please explain)
Any additional information we should be aware of?
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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