Date _______________________________

REGISTRATION FORM 2017-2018

EMMANUEL LUTHERAN PRESCHOOL
Name of Child ________________________________________ Sex ______________________
Name you would like your child to print: _________________________________________________
Address ________________________________________ City/ Zip Code ___________________
Email Address_____________________________________ Home Phone ___________________
Birth Date _______________________________________ Age ____________________
Fathers Name ____________________________________________ Cell Number _______________
Place of Employment ________________________________ Phone __________________
Mothers Name ___________________________________________ Cell Number _______________
Place of Employment ________________________________ Phone __________________
Other children in your family & ages______________________________________________________
Church Affiliation _____________________________________________________________________
Any special problems the staff should know _______________________________________________

Please Check Class Preference:

Select a 1st choice and 2nd choice.
Availability on Total Number of Children Enrolled

Monday/Wednesday Morning (3s) 9:30 12:00 _____________________________

Tuesday/Thursday Morning (3s) 9:30 12:00 _____________________________
Mon./Tues./Wed. Morning (4s) 9:30 - 12:00 ____________________________

Mon./Tues./Wed./Thurs. Morning (4s) 9:30 12:00 _____________________________

Notes on Class Preference: _____________________________________________________

____________________________________________________________________________

PLEASE FILL OUT AND RETURN IMMEDIATELY WITH $45.00 REGISTRATION FEE (NON-REFUNDABLE)
TO: EMMANUEL LUTHERAN PRESCHOOL OFFICE USE ONLY
360 PRINCETON AVENUE
ELYRIA, OH 44035 _________________
CHECK OUR WEBSITE: www.elc-elyria.org

2-day $95.00 3-day - $145.00 4-day $ 190.00

Emmanuel Lutheran Pre-School admits students of any race, color, national and ethnic origin to all the rights, privileges,
programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of
race, color, national and ethnic origin in administration of its educational policies, admissions policies, and athletic and other
school-administered programs.