2025-26 Enrollment Form | Zion Lutheran Preschool

Zion Lutheran Preschool 2025-26 Enrollment

100 W. Main Street, Hummelstown, PA 17036

Email: zluthpreschool@gmail.com

ONLINE PROGRAM REGISTRAITON - COMPLETE ONE PER CHILD

ENROLLMENT OPTION*

CHOOSE ENROLLMENT OPTION

2-Year Old Class (Tues. & Thurs. 9:30-11:30 AM)

3-Year Old Class (Mon., Wed. Fri. 9:30-Noon)

4-Year/Pre-K Class (Mon. thru Thurs. 9:30-12:15 PM)

PAYMENT OPTION*

CHOOSE PAYMENT OPTION

2-Year Old--Full Year: $1,575

2-Year Old-9 Payments: $175 each

3-Year Old--Full Year: $2,115

3-Year Old--9 Payments $235 each

4-Year/PreK - Full Year $2,565

4-Year/PreK - 9 Payments $285 each

ABOUT YOUR CHILD

CHILD'S FULL NAME:

NICKNAME (If Applicable)

Birthday

Month

Day

Year

GENDER

Male

Female

HOME ADDRESS

HOME PHONE

SCHOOL DISTRICT RESIDE IN

WHAT BUILDING CHILD WILL ATTEND K-5

MOTHER/GUARDIAN NAME

MOTHER/GUARDIAN CELL

MOTHER/GUARDIAN EMAIL

MOTHER/GUARDIAN EMPLOYER

FATHER/GUARDIAN NAME

FATHER/GUARDIAN CELL

FATHER/GUARDIAN EMAIL

RELIGIOUS AFFILIATION

RACE

Zion Lutheran Preschool admits students of any race, color, and national or ethnic origin.

LIST ALL ALLERGIES (If none, please enter "NONE")

IS CHILD LIVING WITH BOTH PARENTS (If Not, please specify)

YES

NO

If Not Living With Parents, please Specify

Address of parent (if different from child)

Members in Household (relationship to child, age of brothers & sisters)

Please list 2 local emergency contacts, if parent(s) not available:

Name (Contact 1)

Phone (Contact 1)

Name (Contact 2)

Phone (Contact 2)

Family Physician

Name of Physician

Address/Location

Phone

ABOUT YOUR CHILD

In a few words, please provide your child's overall condition of health, listing anything the school would need to be aware of:

Are there any physical, mental or emotional limitations the school needs to be aware of? (reply NONE, if n/a)

Children must be fully immunized, and forms must be on file/submitted prior to the first day of attendance. These forms are very important and if not received in a timely manner, may jeopardize/delay your child's enrollment.

Upload Proof of Immunizations Here

Can you child care for him/herself in bathroom?

Yes

No

Please specify what bathroom help is given at home so we can follow through and assist at school:

What form of discipline do you use with your child?

Has your child had any previous nursery school experience?

Yes

No

Has your child attended church, neighborhood, or other group activities?

Yes

No

Has your child had an unusual experience, such as an accident, or does your child have any strong fears? If NONE, please enter N/A

How did you hear about Zion Lutheran Preschool??

To explain, illustrate and publicize the Zion Lutheran Preschool and promote outreach of the program's roll in the community, Zion will, from time to time, develop presentation for information and educational purposes. Because Zion is sensitive to the needs of children, and privacy rights of parents, every effort is made to treat public relation matters appropriately and in accordance with the express preferences of parents. Please acknowledge and list your preferences below:

I AGREE that interviews with my child or images (photographs) may be used on the Zion Lutheran Church/Preschool website, or released to local media providers, for any legitimate purpose of the organization, including publication of educational or promotional materials. I understand and agree there will be no compensation for the use of these materials. I realize that I may revoke this permission at any time by providing written notice to the Zion Lutheran Preschool Board.

Please check those that are permitted:

I DO NOT AGREE that interviews with my child or images (photographs) may be used on the Zion Lutheran Church/Preschool website, or released to local media providers, for any legitimate purpose of the organization

Signature

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Date

Month

Day

Year