Pupil Last Name Pupil First Name What name should pupil be called at school? Parent or Guardian Phone Number * Parent or Guardian E-Mail * Street Address * City * Zip Code * Pupil Date of Birth * Pupil’s Sex - Male or Female * Select one from the list Female Male State * Select one state PA NJ DE NY Emergency Contact Phone Number * Emergency Contact Last Name * Emergency Contact First Name * Emergency Contact Phone * Parent or Guardian Last Name * Parent or Guardian First Name * Parent Job Title * Phone Number at Job * Job Email Address * Name of Current Accident & Health Insurance Company * Pupil’s Physician * Physician’s Phone Number *
I understand there is a $50.00 non-refundable registration fee is due at the time of registration. The first tuition payment is non-refundable *
Media Release Form
This is a general permission slip to allow your children’s photographs, taken during notable school events, to be posted on St. John’s Website and Facebook page. Individual children’s names will not be listed.
I give permission to allow this pupil’s - my child’s - photograph, taken during notable school events, to be posted on St. John’s Website and Facebook page. I understand that their names will not be listed. * Select Yes or No Yes - I give permission No - I do not give permission In case of a medical emergency, I give my consent for this pupil, to be transported to the nearest hospital and for the attending physician to adminster the necessary medical treatment. * Select Yes or No Yes - I give permission No - I do not give permission
I verify the above information to be correct, and I understand that completion of this form does not guarantee placement in a Pre-K class. If my child is placed in St’ John’s Pre-K Program, I agree that my child will attend the program for the required number of hours and days as prescribed by St. John’s Lutheran Pre-K staff. I understand that failure to comply with these attendance requirements could result in dis-enrollment. *
Initial and date permission choice.
Initials * Date *
Pre-K Day Schedules
You will be contacted for further payment information
after the registration form has been reviewed. Choose the day schedule you want to register for from the choices below.
Please Select One
5 day ( Monday thru Friday )
4 year olds only
M,T,W,Th and F, includes our 3 day curriculum along with Creative Arts and Enrichment activities
$265.00 July and September-April Payments, and $130.00 May payment.
4 day (Tuesday, Wednesday, Thursday)
3 and 4 year old pupils
Tuesday, Wednesday, Thursday Pre-k & Friday Creative Arts
$215.00 July, and September-April Payments, and a $105.00 May payment.
3 Day (Tuesday, Wednesday and Thursday)
4 year old pupils
Tuesday, Wednesday, and Thursday
$170.00 July, and September – April Payments, and a $85.00 May payment.