Friday, June 23, 2017

Click here to download PDF form.

Email Address*: School Year:

Student's Name
Last Name*: First Name*: Full Middle Name: Gender*: Home Telephone:
Street Address*: City*: State*: Zip Code*:
Birthdate*: Place of Birth: Citizenship*: Social Security Number: Ethnicity/National Origin:
Child lives with: Parent/Guardian Marital Status**:
Father's Last Name: Father's First Name: Cell Number: Work Number: Occupation: Employer:
Mother's Last Name: Mother's First Name: Cell Number: Work Number: Occupation: Employer:
Family's Religion: Pastor's Name: Name of Church: Church's City: Date Baptized:
Has the child previously attended Preschool or a Nursery? Where attended?
Allergies, special conderns, medical restrictions:
Languages spoken/understood: Fears: Takes naps for how long?:
Right or Left-Handed?: Uses Toilet Independently?:
How did you hear of Our Savior?:
Responsibilities at home:
Child's attitude about entering school:
Why have you applied to Our Savior?:
I/We agree to support the teachers, adminsitration, and policies of Our Savior Lutheran School. I/We will pay all the fees in the time and manner stated in the fees schedule and school handbook.
Mother/Legal Guardian Signature Date Signed: Father's/Guardian's Signature: Date Signed:

Parents or legal guardians will need to sign this form before the child attends the preschool, although we do accept it electronically enrollment for families coming from out-of-state.

*For Statistical Use Only – Our Savior does not discriminate on the basis of race, color, religion,national origin, or disability for admissions or any school-related program.

**We assume that both parents or leagal guardians have equal access to students and student records. If this is not true, please provide legal documentation which permits us to withhold student information or to refuse to release the student to either parent or guardian. Our Savior reserves the right to dismiss a student at any time for any reason.

© 2016 Our Savior Lutheran School.
98-1098 Moanalua Rd, ‘Aiea, Hawai‘i 96701
Tel: 808 488-0000 | Fax: 808 488-4515

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