St. John’s Lutheran Church Little Hands Preschool
651-439-5408
It is
my intent to register my child for the fall 2009-2010 school year.
Registration for: 4-5yrs. old by Sept.1 _____ Tuesday, Wednesday, Thursday (tuition $115.00 per month)
3 yrs. old ______ Monday & Friday (tuition $95.00)
Today’s date: _______________ Non Refundable Deposit $45.00 (this will hold your spot) _______ Pd.
Student’s Name: __________________________________ Birth date:______________
Parent’s Name: ______________________________
_____________________________________
Father
Mother
Address:
______________________________________________________
street city zip
Home number: ________________ Work number: _________________ Cell phone:
_________________
Email
address: ____________________________ (for Preschool information/emails)
Family members at home: Name Age
Relationship
Mother’s:
_______________________
________
Father’s : _______________________ ________
_______________________ ________
____________________
_______________________
________
____________________
_______________________ _______
____________________
Is your child baptized?
_______ Your Church
affiliation: ___________________
Does your child have
allergies? _____________ If yes, what kind?________________________
Any
other health problems or concerns? _______________________
Independent
use of bathroom? _____________________ (must be potty trained)
Other information you feel
would be helpful:
Sleep habits ( naps, bedtime, etc.) :
_____________________________________________________
Does your child have any
fears? __________________________________________________
Does your child have any
playmates and what are their ages? : _________________________________
Is your child willing to start
new activities? _____________
Meet new
people? ___________
What is your child’s favorite
activity/pastime? _____________________________________________
How would you describe your
child? ____________________________________________________
______________________________________________________________________________________
Could you be an occasional
volunteer? _________ Classroom ______ Field trip driver
Do you have any special
interests or talents you could share with the children?______________________
What expectations do you have
for your child in this program?_____________________________________
**Please enclose registration
fee with this form and return as soon as possible to the above address.**
Please use the back side of this page for more writing space as
needed. Thank you.