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) leave blank for no preference) 4 year-old class: Monday, Wednesday, Friday: morning afternoon (Circle first choice or leave ($140.00/month September-June) leave blank for no preference)
*Non-refundable registration fee ($50.00):______ received (for office use)______________* Parent/Guardian signature ___________________________ Date ______________________ |
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