Registration

School Registration Form

Note: fields marked as * are required. When all sections have a green checkmark beside it, you can save the form.

Personal Information

Legal Last Name*

First Name*

Grade Enrolling In:*

Birth Date:*

New Student

Ethnicity

Gender

Student Lives With:

Sibling Information

Sibling 1 Name and Age

Sibling 2 Name and Age

Sibling 3 Name and Age

Sibling 4 Name and Age

Student's Church

Name

Affiliation

Member?

Baptized?

Why Do You Desire Your Child To Attend This School?

Following is a list of the 9 most common reasons parents enroll their children in a Christian School. Please rank the top 3 in order from 1 (being the most important) to 3 (being the lease important) that they apply to you personally.

High Academic

Spiritual Development

Good Work Habits

Extended School Care

Social Development

Extracurricular Activities

Self-Esteem Development

Safe Enviroment

Technology

Moral Development

Other

Other Information

How Did You Hear About Us?

Name of School Previously Attended

Previous School Address

Previous School Phone Number

Emergency Contact Information (Parents will automatically be notified)

I authorize Prince of Peace Lutheran Church and Schools to release my children to the following persons:

(1) Full Name*

Relation to Student*

Phone #*

Cell Phone #*

Work Phone #*

(2) Full Name

Relation to Student

Phone #

Cell Phone #

Work Phone #

(3) Full Name

Relation to Student

Phone #

Cell Phone #

Work Phone #

(4) Full Name

Relation to Student

Phone #

Cell Phone #

Work Phone #

Out of State Contact Information

Full Name

Relation to Student

Phone #

Address

Parent Authorization

I understand that if my child has an emergency they will be taken to the 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 physican and/ or hospital. Emergency contacts will be notified by Prince of Peace.

By entering my name below I am providing a digital signature which denotes authorization.

(1) Parent/Guardian Signature*

Date*

(2) Parent/Guardian Signature*

Date*

Student Health Information

Allergies - please provide an EpiPen / Inhaler / Medication / Etc. to the school office if needed.

Peanut Allergy

Bee Allergy

Food Allergy

Medicinal Allergy

Other Allergy

Other Health Needs

Medical Information

Family Physician

Phone Number

Hospital

Phone Number

Family Dentist

Phone Number

Special Learning Needs

Behavioral Concerns

Parental Status:*
Please bring any legal forms to the school office

Parent 1 Information

Relationship to Student:*

Full Name:*

Address:

City:

State:

Zip:

Home Phone Number:*

Cell Phone Number:*

Occupation:

Employer:

Business Phone:

Email:

PoP Emails will automatically be sent to this email

Parent 2 Information

Relationship to Student:

Full Name:

Address:

City:

State:

Zip:

Home Phone Number:

Cell Phone Number:

Occupation:

Employer:

Business Phone:

Email:

I would like to receive PoP emails

Name and Address of Person(s) Responsible for Payment

Full Name:*

Phone:*

Address:

City:

State:

Zip:

List Students Enrolling in 2023-2024 Prince of Peace Lutheran Church and Schools

Name:

Grade:

Name:

Grade:

Name:

Grade:

Name:

Grade:

Fee Schedule

Early Bird Registration (YOU MUST REGISTER BY APRIL 28TH, 2023 TO BE ELIGIBLE FOR EARLY BIRD TUITION)

Tuition

1 Child: $6550

2 Children: $12,400

3 Children: $18,250

4 Children: $24,100

Registration 2023-2024

Registration Fee

Tuition

K - 2: $625

1 Child: $6,850

3 - 8: $550

2 Children: $12,700

3 Children: $18,550

4 Children: $24,400

Technology Fee

Starting 3rd grade: $350

After 2 years in the Technology Program: $150

Tuition Payment Plans

Please select one:

Annual Payment Plan - Full payment of yearly tuition. Payment to be made in school office prior to the first day of school.

Payment of tuition monthly over a 10 or 12 month period, using SMART TUITION. Please be advised, there is a one-time $50 set up fee using this service.

Tuition and Fee Policy:

All fees are non-refundable. Tuition is refundable on a pro-rated basis after a written statement of withdrawal is received, and a 30 day notice is given. Accounts which become more than 30 days delinquent will result in the dismissal of the student. If you anticipate a problem making payments, please contact the school office in advance.

Volunteer Hours Policy:

Each family has the choice of giving 40 service hours of their time or paying $15 for each hour not served.

Signature of Person Responsible for Payments of Tuition and Fees:

By typing in your name below, you are agreeing to paying tuition and fees according to the financial agreement.

Signature:*

Parent/Guardian Name:*

Phone:*

Email:*

Student Name(s):

I hereby give Prince of Peace Lutheran Church and School the absolute right to photograph, interview or film my child(ren) listed above and copyright and / or publish the pertinent materials in whole or in part for printed materials, advertising, public information or any other lawful purpose.
I hereby waive any right that I may have to inspect and/ or approve the finished product or the copy that may be used in connection therewith, or the use to which it may be applied.
I hereby release, discharge and agree to save the above mentioned from any liability by virtue of any blurring, distortion, alteration, optical illusion of use in composite form whether intentional or otherwise, that may occur or be produced in the making of said picture, or in any processing tending towards the completion of the finished project.

Do NOT publish photos of students listed above.

Signature:*

PARENT RELEASE FOR THE ADMINISTRATION OF MEDICATION DURING SCHOOL HOURS 2022-2023

Student Information

Student First Name:

Last Name:

Birthday:

Grade:

Parent Information

Parent First Name:

Parent Last Name:

Phone:

Email:

Medication Information

We, the undersigned, request that a member of the school staff administer to our child the medication prescribed according to the instructions given to us, by our physician:

*We will file any new medication instructions immediately if the medication or dosage is changed.

Any medication that must be given on a daily basis for a long period of time will require a doctor’s letter with a signature.

Physical condition for which drug is given: (If allergic in nature, please specify what type of reaction and indicate in detail those visible symptoms which would give rise to the necessity of administering the medication)

Medication

Dosage and method of Administration

Possible reaction that should be reported to the physician

Therefore the above medication cannot be scheduled for other than during school hours and such medication maybe administered by medically untrained school personnel whenever necessary.

Medication to be continued as above until

Signature:
(Your signature is your authorization)

School Registration Form

Student Information

Contact Information

Parent Information

Financial Agreement 2023-2024

Media and Photography Consent

Release for the Administration of Medication Form

Parent Participation Program 2023-2024