Preschool Registration Form 2021-22 Child's Last Name * Child's First Name * Middle Name * Date of Birth * Street * City * Zip Code * Primary Email * Primary Phone * Gender * Male Female Class First Choice * 3 Year Old 2 Half Day (AM) - T/Th 8:20-11:00 3 Year Old 2 Half Day (PM) - T/Th 12:20-3:00 3-4 Year Old 3 Half Day (AM) - M/W/F 8:20-11:00 3-4 Year Old 3 Half Day (PM) - M/W/F 12:20-3:00 3-4 Year Old (3 Full Days) - M/W/F 8:20-3:00 4 Year Old (5 Half Days AM) - M-F 8:20-11:00 4 Year Old (5 Full Days) - M-F 8:20-3:00 Junior Kindergarten (5 Full Days) - M-F 8:20-3:00 Great Beginnings (young 2's & 3's w/adult) - Tues - 8:30-10:30 Great Beginnings (young 2's & 3's w/adult) - Thurs - 8:30-10:30 Class First Choice Class Second Choice * 3 Year Old 2 Half Day (AM) - T/Th 8:15-11:00 3 Year Old 2 Half Day (PM) - T/Th 12:15-3:00 3-4 Year Old 3 Half Day (AM) - M/W/F 8:15-11:00 3-4 Year Old Half Day (PM) - M/W/F 12:15-3:00 3-4 Year Old (3 Full Days) - M/W/F 8:15-3:00 4 Year Old (5 Half Days AM) - M-F 8:15-11:00 4 Year Old Preschool (5 Full Days) - M-F 8:15-3:00 Junior Kindergarten (5 Full Days) - M-F 8:15-3:00 Great Beginnings (Young 2's & 3's w/adult) - Thurs 8:30-10:30 Great Beginnings (Young 2's & 3's w/adult) - Tues 8:30-10:30 Class Second Choice Mother's Name: * Cell Number: * Home Church: * Father's Name: * Cell Number: * Home Church: * Are you a returning family, or do you currently have children at Immanuel, Preschool-8th grade? * Yes No Please list any school or childcare your child has previously attended: Has your child ever received services for speech, occupation therapy, developmental delays or other needs? * Yes No If yes, please explain and note location: Admission Policy: Immanuel Lutheran School admits students of any race, sex, color, national and ethnic origin to all the rights and privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, sex, color, national or ethnic origin in administration of its education policies and athletic or other school administered programs. Please type your full name and date in the box below (this serves as your signature): * If you are human, leave this field blank. Submit