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TRINITY LUTHERAN CHURCH PRESCHOOL
Registration Form
2010-2011

Child’s Name: _________________________________________ Sex: _____________

Address: ___________________________________________ City: _______________

Zip: ___________ Phone: _________________ Cell/Mobile/Pager: _________________

E-mail address:____________________________

Name to be used in school: __________________ Date of Birth: ____________________

Mother’s Name: ________________________ Father’s Name_____________________

Mother’s Employer: _____________________ Father’s Employer __________________

Business Phone: _________________               Business Phone:____________________

Our church home is:_________________ We are looking for a church home___________

Other Children in Family: Name: ______________________________ Age: __________

                                      Name: ______________________________ Age: __________

Does your child have any health problems or allergies?_______ If so, explain:__________

_____________________________________________________________________

I would like to enroll my child in the following class:
__________2 ˝ year old class – Tuesday & Thursday
__________3 year old class – Tuesday & Thursday
__________3 year old class – Monday, Wednesday & Friday
__________4 year old class – Monday, Wednesday & Friday
__________4 year old class – Monday through Thursday
__________4 year old class – Monday through Friday
My non-refundable registration fee accompanies this Registration Form. ($100.00)

Parent’s Signature: ____________________________________ Date: _____________

OFFICE USE ONLY – IDENTITY VERIFICATION
Place of Birth:Birth Date:
Birth Certificate Number:Date Issued:

TRINITY LUTHERAN CHURCH PRESCHOOL
Payment Schedule

I hereby enroll my child,_____________________________________, in Trinity Lutheran Church Preschool for the year 2010-2011. I have indicated with a check mark which of the following payment options is preferred. I understand that a $10.00 late fee will be charged if payment is not received by the fifth (5th) of the month.
Plan I – Annually
          Full tuition payment due August 1, 2010
_____ Two & ˝ year old class $1,260.00
_____ Two Day Threes $1,260.00
_____ Three Day Threes $1,665.00
_____ Three Day Fours $1,665.00
_____ Four Day Fours $2,115.00
_____ Five Day Fours $2,520.00
Plan II - Three Installments
          Three equal installments: First installment due August 1, 2010
_____ Two & ˝ year old class $420.00
_____ Two Day Threes $420.00
_____ Three Day Threes $555.00
_____ Three Day Fours $555.00
_____ Four Day Fours $705.00
_____ Five Day Fours $840.00
             Second Installment due November 1. Third Installment due February 1
Plan III – Monthly
          9 Monthly Payments: First payment due August 1, 2010
_____ Two & ˝ year old class $140.00
_____ Two Day Threes $140.00
_____ Three Day Threes $185.00
_____ Three Day Fours $185.00
_____ Four Day Fours $235.00
_____ Five Day Fours $280.00
          **REGISTRATION FEES ARE NON-REFUNDABLE**
I understand that no refund of the tuition will be made upon withdrawal of my child except for the following reasons:
1. If parents are transferred from the city. A month’s notice must be given.
2. If the child becomes ill and a doctor recommends withdrawal. A note from the doctor is required.
I further understand that payment must be made even if my child does not attend school for any other reasons.
Signed:___________________________________________ Date:________________