FLS - EEC Enrollment

APPLICATION FOR ENROLLMENT
Child's Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
School year
This application is valid only when all parts are complete and signatures are affixed below to indicate acceptance of the conditions stated below. First Lutheran does not discriminate in its enrollment policies on the basis of race, sex, color, national or ethnic origin.

Completion of this application does not assure enrollment.

The full registration fee of $175.00 is due at the time of enrollment. Acceptance is for a one-year period only.

Application for re-enrollment must be made annually. Registration Fees are non-refundable.

As parent (s) or guardian (s) of the above-named child, I (we) agree:
- To support the philosophy and policies of the First Lutheran Early Education Center as stated in the Parent Handbook at www.flchurch.org, and by cooperating with the teachers and administration.
- To pay tuition charges and required fees according to the schedule established by the school.
- Provide the necessary health and immunization records and other school data requested.
What is your major reason for choosing First Lutheran School?
How did you hear about our school?
Please list any other children applying for First Lutheran School:
Name
Grade
Name
Grade
Parent (s) Signature (s):
Father’s (or guardian’s) signature
Mother’s (or guardian’s) signature
Date

MonthDayYear
Date

MonthDayYear
CHILD AND FAMILY PROFILE

Information on this registration form is for School Office use only.
Number of Student(s)*
Student 1 Name

First NameLast Name
Student 1 Gender

MaleFemale
Student 1 Age
Student 1 Birthdate

MonthDayYear
Student 2 Name

First NameLast Name
Student 2 Gender

MaleFemale
Student 2 Age
Student 2 Birthdate

MonthDayYear
Student 3 Name

First NameLast Name
Student 3 Gender

MaleFemale
Student 3 Age
Student 3 Birthdate

MonthDayYear
Father Name*

PrefixFirst NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Cell
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Employer
Occupation
Mother Name*

PrefixFirst NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Cell
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Employer
Occupation
Parents are

MarriedSeparatedDivorcedLegal Guardians (relationship)
If parents are divorced/separated, which parent has financial responsibility for student?
Whom does the student live with?
Church membership / fellowship at:
City
Have children been baptized?
INFANT & TODDLER Programs

Age 6 weeks to 2 1/2 years
Our Infant and Older Toddler classes are only full days and are offered on a 12-month basis. Those wishing to start at a later date will be put on a waiting list for any openings coming up during the year.

Note: Children must be at least 6 weeks old to be accepted into our Infant program.
Child’s Name*
Birthdate*

MonthDayYear
Please select which program you prefer*

Five Full DaysThree Full DaysTwo Full Days
OLDER TWO YEAR OLD & PRESCHOOL Programs

Starts at age 2 1/2 years old by September 1st
Child’s Name*
Birthdate*

MonthDayYear
Please select when you are interested in starting*

JulyAugustSeptember
Please indicate the preferred program sessions for both Summer and September through June. The preschool program has the option of taking July and/or August off, with your space still reserved for your child in September.

Please indicate which program (s) you prefer (1st choice, 2nd choice, 3rd choice)
Summer Session*

July & AugustJuly onlyAugust onlyNO Childcare needed for July/August
Session*

Five Full DaysThree Full DaysTwo Full Days
September through June*

Five Full DaysThree Full DaysTwo Full Days
NOTE: Please carefully consider how many days per week you need your child to attend.

$30 change fee applies if you request a program change after:
- April 25, 2025, for the 2025-2026 school year.
Should be Empty:

APPLICATION FOR ENROLLMENT

CHILD AND FAMILY PROFILE

INFANT & TODDLER Programs

OLDER TWO YEAR OLD & PRESCHOOL Programs