Preschool Registration Form

Student Name *
Student Name
I would like to register my child for *
Home Address
Home Address
Best number to text for preschool reminders, announcements, snow days, emergencies, etc.
Best number to text for preschool reminders, announcements, snow days, emergencies, etc.
Birth Date
Birth Date
Baptism Date
Baptism Date
HSLC Member
Parent/Guardian 1 Name *
Parent/Guardian 1 Name
Parent/Guardian 1 Best Contact Number
Parent/Guardian 1 Best Contact Number
Parent/Guardian 2 Name
Parent/Guardian 2 Name
Parent/Guardian 2 Best Contact Number
Parent/Guardian 2 Best Contact Number
With whom does the child reside?
Primary Emergency Contact NOT already listed on this form
Primary Emergency Contact NOT already listed on this form
Emergency Contact Phone Number
Emergency Contact Phone Number
As parent, or legal guardian, I authorize a qualified physician to examine the above-named child and in the event of injury to administer emergency care and to arrange for any consultation by a specialist, including a surgeon, as deemed necessary to ensure proper care of any injury. I understand every effort will be made to contact a parent or guardian to explain the nature of the problem prior to any involved treatment. In the event it becomes necessary for Holy Spirit Lutheran Church staff or volunteers to obtain emergency care for your child, neither the staff, volunteers nor Holy Spirit Lutheran Church assumes financial liability for expenses incurred because of an accident, injury, illness, and/or unforeseen circumstances.
Holy Spirit Lutheran Church is committed to keeping children safe. All adults volunteering with children undergo background screening. Our guidelines are outlined in a Safe Haven policy, available in our church office. We also ask that you attend a training session if you would like to volunteer in your child’s classroom. Contact the church office for a schedule of upcoming classes or to register for the next class.
Please write your name below
Child's Personal History
Check if applicable
My child is
Social Relationships
By nature, my child is
check all that apply
Eating
There will be room for more allergy information in the "special needs" section below
We cannot always accommodate special dietary restrictions, but the teacher will work with you to see what we can do.
My Child
Behavior
Allergies and Other Special Needs*
*Such as physical/mental challenges, learning disabilities, sensory issues, etc.