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Registration Form
(one per family)
Parent/Guardian Information
*
Indicates required field
Parent/Guardian 1 Name
*
First
Last
[object Object]
Parent/Guardian 1 Address (if different from child)
*
Line 1
Line 2
City
State
Zip Code
Country
Parent/Guardian 1 E-mail
*
Parent/Guardian 1 Cell Phone
*
Parent/Guardian 1 Relation to Child
*
Parent/Guardian 1 Info Included in Class Roster
*
Name
Phone
E-mail
Address
Parent/Guardian 2 Name
*
First
Last
Parent/Guardian 2 Address (if different from child)
*
Line 1
Line 2
City
State
Zip Code
Country
Parent/Guardian 2 Email
*
Parent/Guardian 2 Cell Phone
*
Parent/Guardian 2 Relation to Child
*
Parent/Guardian 2 Info Included in Class Roster
*
Name
Phone
E-mail
Address
Custody
Is there a legal custody agreement regarding your child(ren)?
*
Select one
Yes - I will provide a copy to the school
Yes - the agreement is on file at the school
No
With whom does the child(ren) reside?
*
Church Information
Church Membership
*
Select One
No church membership
Christian church member
Non-Christian church member
Church Name (if applicable)
*
Would you like information on Fairlawn Lutheran Church?
*
Select one
Yes
No
Student 1 Information
Student 1 Name
*
First
Last
[object Object]
Student 1 Name to Be Used in Class
*
Student 1 Sex
*
Select one
Male
Female
Student 1 Birthdate (MM/DD/YY)
*
Student 1 Address
*
Line 1
Line 2
City
State
Zip Code
Country
Has Student 1 attended preschool/daycare before?
*
Select one
Yes
No
If yes, where (Student 1)?
*
Has Student 1 been baptized/christened?
*
Select one
Yes
No
For what class are you registering Student 1?
*
Select one
3A Mon/Wed AM
3B Tues/Thur AM
4A Mon/Wed/Fri AM
4B Tues/Thur/Fri AM
4C Mon-Thur AM
5A or 5B Mon-Fri AM
Kinder - all day
Does Student 1 separate easily from parent?
*
Select one
Yes
No
Do you suspect Student 1 has hearing or speech difficulties?
*
Select one
Yes
No
Is Student 1 receiving outside services?
*
No
Speech
Occupational therapy
Physio
Other
Is there other info we should know about Student 1?
*
Student 2 Information
Student 2 Name
*
First
Last
Student 2 Name to be Used in Class
*
Student 2 Sex
*
Select one
Male
Female
Student 2 Birthdate MM/DD/YYYY
*
Student 2 Address (IF DIFFERENT FROM STUDENT 1)
*
Line 1
Line 2
City
State
Zip Code
Country
Has Student 2 attended preschool/daycare before?
*
Select one
Yes
No
If yes, where (student 2)?
*
Has Student 2 been baptized/christened?
*
Select one
Yes
No
For what class are you registering Student 2?
*
Select one
3A Mon/Wed AM
3B Tues/Thurs AM
4A Mon/Wed/Fri AM
4B Tues/Thurs/Fri AM
4C Mon/Tues/Wed/Thurs AM
5A or 5B Mon-Fri AM
Kindergarten Full-day
Does Student 2 separate easily from parent?
*
Select one
Yes
No
Do you suspect Student 2 has hearing or speech difficulties?
*
Select one
Yes
No
Is Student 2 receiving outside services?
*
No
Speech
Occupational therapy
Physio
Other
Is there other info we should know about Student 2?
*
Student 3 Information
Student 3 Name
*
First
Last
Student 3 Name to Be Used in Class
*
Student 2 Sex
*
Select One
Male
Female
Student 3 Birthdate MM/DD/YYYY
*
Student 3 Address (IF DIFFERENT FROM STUDENTS 1 & 2)
*
Line 1
Line 2
City
State
Zip Code
Country
Has Student 3 Attended preschool/daycare before?
*
Select One
Yes
No
If yes, where (Student 3)?
*
Has Student 3 been baptized/christened?
*
Select One
Yes
No
For what class are you registering Student 3?
*
Select One
3A Mon/Wed AM
3B Tues/Thurs AM
4A Mon/Wed/Fri AM
4B Tues/Thurs/Fri AM
4C Mon/Tues/Wed/Thurs AM
5A or 5B Mon-Fri AM
Kindergarten Full-day
Does Student 3 separate easily from parent?
*
Select One
Yes
No
Do you suspect Student 3 has hearing or speech difficulties?
*
Select One
Yes
No
Does Student 3 receive outside services?
*
Select One
No
Speech
Occupational therapy
Physio
Other
Is there any other info we should know about Student 3?
*
Submit
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