Forms

Prince of Peace Lutheran Preschool

Application for Admission

Child’s Full Name:________________________ Child’s Birth Date:_______

Address:____________________________________________________

City:_______________________________ Zip Code:_______________

Please circle the days your child will attend school: Mon. Tues. Wed. Thurs. Fri.

What will be the general hours your child will attend

school:____________________________

Are you an active member of a Christian Church?_______

Church Name:_________________

Mothers

Name:________________________________________________

Address if different from

child’s:________________________________________________

Mother’s Home Phone:___________________

Mother’s Work Phone:___________________

Place of employment:________________________

Mother’s Cell Phone:___________________

E-Mail:__________________________________

Father’s Name:__________________________________________

Address if different from

child’s:________________________________________________

Father’s Home Phone:___________________

Father’s Work Phone:___________________

Place of employment:_________________________

Father’s Cell Phone:___________________

E-Mail:__________________________________

In the event that the parents cannot be reached, please contact:

Name __________________Phone______________Relationship_______

Persons authorized to pick up my child:

Name __________________Phone______________Relationship_______

ALLERGIES or MEDICAL CONERNS:________________________________________________

Signature of parent/guardian: Date:

X______________________________________ ____/____/____

(To be completed by Prince of Peace Administration)

Date of Admission:____________________

Date left:____________________

Prince of Peace Preschool