Registration Form | Hosanna Lutheran Childhood Center

1 Select Program

2 Child Information

3 Registration Fee

Child Admissions Information
Mother's Name*
First Last
Mother's Email*
Enter Email Confirm Email
Address*
Street Address City State ZIP Code
Mother's Home Phone
Mother's Work Phone
Mother's Cell Phone*
Father's Name
First Last
Father's Email
Enter Email Confirm Email
Address (if different)
Street Address City State ZIP Code
Father's Home Phone
Father's Work Phone
Father's Cell Phone
Name your child is called at home
Name you wish your child to learn to recognize in print and writing
Child lives with
Names and Ages of Siblings
Have any of your other childern attended HLCC?
Has your child attended any structured activities?
Has your child attended any other preschool?
Did a current student refer you to HLCC? If so, who?
What are your goals for your child this school year?*
Are there any family or custody issues that would affect your child attending HLCC? In the case of a divorce or separation, the Center cannot deny a parent access to a child unless legal documentation has been provided to the Center.*

Hosanna Lutheran Childhood Center 2018 – 2019 Registration Form