Reformation Lutheran School
4435 SE Tualatin Valley Highway
Hillsboro, OR 97123
Preschool Enrollment Form For 2011-2012
Child:_______________________________________ Birth Date:______________________
Baptized? Y N
(circle one)
Parent(s)/Guardian(s):
1. Name:
____________________________Relationship:__________ Phone: ______________
__________________________________________________________________________
Address City State Zip
Cell and/or pager
#_____________________________________________
Employer
______________________________________Work phone # __________________
__________________________________________________________________________
Address
City State Zip
2. Name:
___________________________Relationship: ____________Phone: _____________
__________________________________________________________________________
Address
City
State Zip
Cell and/or pager
#____________________________________________
Employer
______________________________________Work phone # __________________
__________________________________________________________________________
Address City
State Zip
In the event neither parent nor guardian
can be contacted, name a relative or friend to be called if your child is ill:
Name:
_____________________________________________________________________
Relationship: ________________Phone: ___________________________________________
Name:
_____________________________________________________________________
Relationship:
________________Phone: ___________________________________________
Enroll
student in:
3 year-old class: Tuesday and Thursday: morning afternoon (Circle first choice or
($90.00/month September-June)
4 year-old class: Monday, Wednesday, Friday: morning afternoon (Circle first choice or leave
($140.00/month
September-June)
*Non-refundable registration fee ($50.00):______ received (for
office use)______________*
Parent/Guardian signature
___________________________ Date ______________________