Form Entry

I am a Current Member
(Yes/No)

I have been baptized*
(Yes/No)

We Require all Non-Lutheran Parents to attend our "What We Teach & Believe" class conducted by the Pastor. In this class you will be informed of doctrine being taught at Prince of Peace. Please look for dates for the classes and when they will be held.

Why do you desire your child in this school? (Select up to 3)

High Academic

Spiritual Development

Good Work Habits

Extended School Care

Social Development

Extracurricular Activities

Self-esteem Development

Safe Environment

Technology

Moral development

Emergency Contact Information

Emergency Contact Name*

Relationship to Student*

Home or Cell Phone Number*

Work Phone Number

I authorize Prince of Peace Lutheran Church and School to release my child to the above mentioned person

Out of State Contacts

Contact Name*

Relation to Student*

Cell Number*

Address

Student Health Information

Peanut Allergy

Bee Allergy

Food Allergies

Medicinal Allergies

Other Allergies

No Allergies

Other Health Needs

Any Other Health Notes

Student Medical Information

Family Physician

Drs. Phone Number

Hospital Name

Hosp. Phone Number

Family Dentist

Dentist Phone Number

Special Learning Needs*
(Please enter NA if this does not apply)

Behavioral Concerns*
(Please enter NA if this does not apply)

I understand that if my child has an emergency they will be taken to closest emergency room to Prince of Peace. I will pay physician’s fees not covered by insurance. If necessary, I authorize emergency treatment by any certified paramedic, licensed physician and or hospital. Emergency contacts will be notified by Prince of Peace.

Student Lives With*

Parent Status*

Parent 1 First Name*

Parent 1 Last Name*

Parent 1 Relation to Student*

Parent 1 Address*

Parent 1 City*

Parent 1 State*

Parent 1 Zip*

Parent 1 Home Phone

Parent 1 Cell Phone

Parent 1 Drivers License

Parent 1 Social Security No*
(Last 4 digits only)

Parent 1 Occupation

Parent 1 Employer

Parent 1 Employer Phone No

Parent 1 Email Address*

Automatically send P.O.P. emails

School Enrollment Form (2022-2023)