Bethel Lutheran Preschool
4925 Farmingdale Drive
Colorado Springs, CO 80917
(719) 591-9997
   
   
Date Received _______
Check # ____________
Amount                   $75
Bethel Preschool Registration 2008-09

Your child must be 3 years old and toilet-trained by September 15th or earlier.

4 year old class______         3 year old class______

Morning Classes (9:00 a.m. – 1:00 p.m.)

4 day(MTWTh) ____     2 day (M,W)____     2 day(T,Th) _____

Child Information:
Child’s Full  Name__________________________________________________
Child’s Name to be used_________________________       Male____Female____
Date of Birth_________________________          ____Verified by Birth Certificate
Primary Residence:     Both Parents___   Dad Only___   Mom Only___    Other____
Previous Preschool Experience_________________________________________
Allergies/Food Restrictions/Other Special Needs____________________________
                
___________________________________________________________________________________________________________

Parent/Guardian Information—complete both columns if applicable:
Name______________________________ Name______________________________
Relationship_________________________ Relationship_________________________
Employer___________________________ Employer___________________________
Home Address_______________________ Home Address_______________________
City________________________________ City________________________________
State/Zip____________________________ State/Zip____________________________
Home Phone_________________________ Home Phone_________________________
Work Phone__________________________ Work Phone__________________________
Cell Phone___________________________ Cell Phone___________________________
E-mail_______________________________ E-mail_______________________________

How did you hear about our Preschool? 
 ___We are Bethel Members    ____Friend     ____Brochure     ____Signage   ____Phone Book

*IRS PROCEDURE 75-50 REQUIREMENT

The Bethel  Lutheran Preschool 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, scholarship and loan programs, and athletic and other school administered programs.