Child Care Only Form - St. Michael Lutheran School

Parent Information

Father
Step-Father
Guardian

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Parent Information

Mother
Step-Mother
Guardian

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

With Whom Does the Child Live? *

Without a court-ordered custody agreement, child(ren) may be released to either parent at any time.

Who is Responsible for Tution? *

Student Information

If your child has an IEP or 504 plan, copies must be provided and reviewed by the administration before admissions.

Name of Child *

First

Last

Date of Birth *

Gender *

Male
Female

Please Indicate which Room your Child will be in:

Ethnicity *

Excel in Giving

Excel In Giving Forms will need to be completed.

Please check which payment plan you intend on using: *

9 Months
12 Months

Name of School District in which Student(s) Resides: *

Name of School/Daycare Student Previously Attended: *

Any Learning, Health or Physical Disabilities that should be known? (Please Include any Allergies or Medical Conditions)

Do you Attend Church? *

Yes
No

Name of Church Currently Attending:

Has the Child(ren) been Baptized? *

Yes
No

Parental Consents

Photo Agreement

I grant permission for my child(ren) to be included in any photos or videotapes the school may use for school bulletin boards, newsletters, yearbooks, web pages, promotions, class projects, etc. Furthermore, I consent that such photographs and or videos shall be the property of St. Michael Lutheran School and Christ for Kids (SMLS/CFK), which has the right to duplicate, reproduce, and make other appropriate uses as SMLS/CFK deems necessary.

Parent's Printed Name *

Parent's Signature *

School Directory Agreement

I grant permission for my family and child(ren)’s name, address, phone number to be used for church and school business, and to be included in a Parent Directory that will be made available to all St. Michael Lutheran School and Church families. The information in the directory may not be used for promotional, business, or political mailings or phone calls. It is intended solely for the convenience and information of SMLS/CFK families.

Parent's Printed Name *

Parent's Signature *

Non-Refundable Registration Fee

I understand the registration fee is non-refundable and that the registration fee is due with this form.

Parent's Printed Name *

Parent's Signature *

Health

I affirm that to the best of my knowledge, my child(ren) is in good physical health to attend SMLS/CFK. I acknowledge that SMLS/CFK will take due diligence with the health and safety of my child(ren) and I will not hold SMLS or CFK liable for any event relating to any preexisting medical conditions, disclosed or undisclosed.

Parent's Printed Name *

Parent's Signature *

Diaper Rash Cream

I give per mission to the staff at Christ for Kids to apply diaper rash cream (provided from home) whenever it is needed to my child throughout the day.

Parent's Printed Name *

Parent's Signature *

Childcare Needs

Please note when you anticipate needing care - we understand your schedule may change.

Student

Indicate Typical Days and Times for Drop Off/After School

A Note about Call Ahead and Drop In Childcare:

Christ for Kids strives to be flexible with scheduling policies. However, to ensure proper staffing we request that families call ahead when additional care is needed. Should space not be available, we reserve the right to refuse care to students who have not prescheduled their attendance.

ST. MICHAEL LUTHERAN SCHOOL

Parent Information

Parent Information

Student Information

Excel in Giving

Parental Consents

Photo Agreement

School Directory Agreement

Non-Refundable Registration Fee

Health

Diaper Rash Cream

Childcare Needs

A Note about Call Ahead and Drop In Childcare:

INFORMATION

Admissions

Academics

Testimonials

Emergency Drills

RESOURCES

Sycamore School Portal

Make Tuition Payment

Tuition Assistance - TRIP