Nursery School Registration 2023-2024 - The Lutheran Church of the Holy Spirit

Date

Check #

Holy Spirit Member?

Holy Spirit Congregation Member

Enrolled?

Child/Sibling Previously Enrolled
New Enrollment

Select Your Class(es) by clicking on your choice(s).

(Meets 9:00-11:45/12:30-3:00)

First School Experience

Tadpoles (Age 3 by Dec. 31, 2023) - 2 Days (Tues/Thurs AM) - $150.00/month
Pollywogs (Age 3 by Dec. 31, 2023) - 3 Days (Mon/Wed/Fri AM) - $185.00/month

.

Cubs... Getting Ready for Kindergarten

Panda Bears (Age 4 by Dec. 31, 2023) - 4 Days (Mon/Tues/Wed/Thurs AM) - $220.00/month
Brown Bears (Age 4 by Dec. 31, 2023) - 3 Days (Mon/Tues/Thurs PM) - $185.00/month
Polar Bears (Age 5 by March 1, 2024) - 4 Days (Tues/Wed/Thurs/Fri AM) - $220.00/month

Other Programs For Play and Enrichment (A minimum class size is required to offer some classes)

Playful Penguins for ages 3-5 years - 1 Day (Tues or Wed 11:45-2:15) - $100.00 for 4 weeks
Playful Penguins for ages 3-5 years - 2 Days - (Tues and Wed 11:45-2:15) - $200.00 for 4 weeks

Your Child's Profile

Name *

First

Last

My child preferrs to be called: *

Date of Birth *

Gender *

Male
Female

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Email

(Will be used for nursery school communication)

Primary Contact Number During School Hours *

Your Child's Family

Is English the primary language spoken at home?

Yes
No

If no, list primary language.

Child Lives With

If Other, Describe

If Parents Are Divorced, Separated, Single, List Any Special Arrangements

Primary Parental Contact *

First

Last

Occupation

Contact Cell Phone *

Email *

Address (If different from Child's)

Address Line 1

Address Line 2

City

State

Zip Code

Secondary Parental Contact

First

Last

Secondary Contact Occupation

Secondary Contact Cell Phone

Secondary Contact Email

Secondary Contact Home Address (if different from child's)

Address Line 1

Address Line 2

City

State

Zip Code

Other Members of Household

Name

Age

Relationship

Name

Age

Relationship

Name

Age

Relationship

Name

Age

Relationship

Child Information

My child enjoys

My child's relilgious group affiliation

Additional information I'd like to share about my child

All information is confidential and will only be shared with your child's teacher and the school director.

Health Information

Medical Conditions:

Allergies

Diabetes?

Diabetes

Other Medical Conditions

Medications

Current in immunizations? *

Yes
No

(If child is not current, a waiver form will need to be completed.)

Has your child ever received learning support prior to preschool? (example: speech, physical/occupational therapy)

Yes
No

If yes, please describe and share current I.E.P.

Additional Information

To complete the registration process, the non-refundable fee ($75.00) must accompany the form. One registration fee is required per child. You can pay via check, or on line after completing this form. Checks should be made payable to Holy Spirit Christian Nursery School. The registration fee holds a spot in a class until June 15th, when the September tuition payment is due. Tuition is a yearly fee and divided into nine payments. The first installment (September tuition) is due on June 15th. This payment will reserve your child's spot in the class. No initial tuition payments (September) are refunded after July 1st..

I give my permission to share our name, address, phone number and email address with other members of the nursery school community for use in the Nursery School Directory *

Yes
No

Signature of parent or guardian