Emanuel Llltheran School - Emanuel Lutheran School

Emanuel Lutheran
1. 79 East
Main
631..758.2250
Patchogue-Medford
Stxeet
Patchogue,
Fax 631..758.2418
School Office of Student
School
N e'W"York
1.1. 772
ema.nhithpatchsc.org
Health Services
Dental Health Certificate - Optional
Parent/Guardian: New York State law (Chapter 281) permits schools to request a dental examination in the following grades:
school entry, K, 2, 4, 7, & 10. Please take this form with you when your child visits the dentist. Have the dentist fill it out and return
it to the school nurse. Please note the date of the exam needs to. be within 12 months of the start of tbe school year in which it is
requested.
Child's Name:
Sex:
D.O.B.:
_
BuUding:
Grade:
-----
Section 1 to be completed by the Dentist
Section I.
I. The Dental Health condition of
on
(date of exam). The date of
the exam needs to be within 12 months of the start of the school year in which it is requested. Check one:
CJ Yes, the student listed above is in fit condition of dental health to permit his/her attendance at the public schools.
Cl No, the student listed above is not in fit condition of dental health to permit his/her attendance at the public schools.
NOTE: Not in fit condition of dental health means that a condition exists that interferes with a student's ability to chew, speak or focus
on school activities including pain, swelling or infection related to clinical evidence of open cavities. The designation of not in fit
condition of dental health to permit attendance at the public school does not preclude the student from attending school.
Dentist's Name and address (please print or stamp)
***.** ••*****************.**.*****.*****
Dentist's Signature
•••••••• *************.*****.*****.**********.**********************
Section II
Optional Sections -If you agree to release this information to your child's school, please initial here.
II. Oral Health Status (check all tbat apply)
Cl Yes Cl No
Q Yes Q No
Q Yes Cl No
Caries Experience/Restoration History- Has the child ever had a cavity (treated or untreated)?
[A filling temporary/permanent) OR a tooth that is missing because it was extracted as a result of caries OR an open
cavity.]
Untreated Caries - Does this child have an open cavity? [At least 1/2 nun of tooth structure loss at the enamel
surface. Brown to dark- brown coloration of the walls of the lesion. These criteria apply to pits and fissure cavitated
lesions as well as those on smooth tooth surfaces. If retained root, assume that the who Ie tooth was destroyed by caries.
Broken or chipped teeth, plus teeth with temporary fillings, are considered sound unless a cavitated lesion is also
present.]
Dental Sealants Present
,1
Other problems (Specify):
_
Section III
III. Treatment Needs (check aU that apply)
No obvious problem. Routine dental care is: recommended. Visit your dentist regularly.
May need dental care. Please schedule an appointment with your dentist as soon as possible for an evaluation.
Immediate dental care is required. Please schedule an appointment immediately with your dentist to avoid problems.
June 2009
n_
.Emanuel Lutheran School
179 East
I:vIain Street
Patchogu.e~
631.758.2250
Fa::s:
631.758.2418
-
Patchogue-Medford
School Office of Student
N e-w-York 11772
=anlut:hpat:chsc.org
Health Services
HEALTH HISTORY INFORMATION
CHILD'SN~m:_'
HAS CHILD HAlt:
__
YIN
IF SO, WHEN?
Anemia
Arthritis
HAS CHILD HAD:
YIN
IF SO, WHEN?
Measles
Meningitis
Mtgraiaes
Mumps
Astbma
Cardiac Disorder
Chicken Pox
Diabetes (Type 1)
Operations
Ol·tbopedic
Disorder
Diabetes (Type 2)
Ear Disorder
Pnenmenia
Rheumatic Fever
Scarlet Fever
Seizure. Disorder
Serious Injuries
Sore! Throats
Tuberculosis
Urinary Disorder
Other
Elevated
'Cholesterol
German Measles
Head Injury
Or Concussion .
High OT Low
Blood Pressure
Hives or Eczema
_
Allergies:
Bee
Stings__
Food__
MedicatJioD_
Otber:
_
Has the student ever had aill insect bite followed i[JY a rash l'
Yes
---
No
Has the student ever complained about any joint pain?
Yes
--- No--.,..--
May the student participate ftn a regular unlimited physical education program?
If 1110, please explam:
Is the student talldng any medications?
Yes
No
If yes, w.hat?
Yes
No
_
_
--'-o .;-.'
_
Is there any speciaf in formation,
physical or emotional, concerning the child the school should be aware
of that would beh) in the protection of general health during the period of school years? Yes_ N 0__
If.so, what?
_
Parent's Signature
Date
_
lEMANUEL I.UfHERAN SCHOOIL
1179Et~ST MAIN STREET
IP'ATCHOGUE, NY 117?2
(~ 1-'/58-2250
First Name:
_
last Name:
Middle IName:
------.----------
Phone:l___)
Family Physic-ian:
_
Address:
DOES YOUFl: CHILD HAVE J~NY SPECIAL HEAL Tt-I PROBLEMS (including allergies, asthma,
or medications):
Does the! ehtld weal£" g~a$se.~~/c;orntactIEmses'?
If at any time the above information
Signature of Pal"ent/Guardian
..
DYes
o No
must be changed, I will notify the school in writing.
_
Date
_
,,
Emanuel Lutheran School
Student Immunization Record
This record is part of the student's permanent school record and shall transfer with the student's school record to any new school.
Upon completion of this form, please submit or fax it to the school office to be filed in the Health Office.
Student
Student
Name
Information
_ Gender
Name of Parent/Guardian
_
Vaccine
Information
Date of Birth
1st
2nd
3rd
.
4th
SCHOOL AND EARLY CHILDHOOD
PROGRAM USE ONLY:
5th
Tdap
1.
(O·Olphtheria, T·Tetanus, P·Pertussis, aP-aceliular
Pertussis
ALL REQUIREMENTS MET date:
Adequately Immunized
Or Exemption was granted for:
o
o
Polio
Haemophiluslnfluenzae
Mumps,
and Rubella
-...,"",
Religious
2.
3.
(MMR)*
l't dose must be received on or after the l't birthday
Disease
11
Measles
Medical (Expires· on: __
o Personal
Conditional Admission date:
Not-in-Compliance date:
'If exemptionistemporary, student.isconditionally
admitted;enter date in (2) and leave (1) blank.
b (Hib)
Pneumococcal
Measles,
_
o
Tdap is preferred for the 7" grade
requirement, but Td is acceptable.
Tdap or Td Booster
_
_
Record the month, day, & year vaccine was given.
VACCINE
DTP, DTaP, DT,Td,
IGr~de
.D MalE!. 0 Female
(Rubeola,10 day, red measles)"'*
If vaccine Is given in the combined form (MMR), enter
the complete date in the appropriate MMR box.
** If vaccine is given as a single antigen, enter the
Mumps**
Verification:
My child has history of the chickenpox disease,
and therefore, does not need the Varicella
vaccine.
date(s) in the appropriate boxes.
Signature of Parent/Guardian
Rubella
(Germanmeasles,3 day measles)**
Hepatitis
B (HBV)
Varicella
(Chickenpox)
Age of child at time of disease:
1" dose must be received on or after the l't birthday.
Hepatitis
Emanuel Lutheran School
A (HAV)
179 East Main Street, Patchogue, NY 11772
www.emanluthpatch.org
Must be received on or after the 1" birthday.
631-758-2250
Fax631-758-2418
Record Source: 0 Physician 0 Registered Nurse 0 Health Oept.
I have reviewed the records available and to the best of my knowledge,
Authorized
this student has received the above immunizations
Signature:
Oate:
,t
_
Title:
_
L lltheran School
Emanuel
179 East Main
631.758.2250
Home and Scb.oal w:Ith Cbr.Ist
Patchogue-Medford
-----
[
~.
._-_._-------
.
__ ._---
Street
Patchogue,
Fax 631.758.2418
Ne"'W York
11772
emanlu1:b.pat:chsc.org
School Office of Student Health Services
.--~-_--.---].
.
Th1MUNIZATION INFORMATION
-------_ .. -... _--.---_. __ ._.._----_.---_.-------_ .._----_._----'-------,,---
.
-.---
New York State Public Health Law, Section 2164 mandates that schools shall not permit a child to be admitted unless the parent
provide the school with a certificate of immunization or proof from a physician, nurse practitioner or physician's assistant that the
child is in the process of receiving the required immunizations.
.
Name of Immunization
Number of Doses Re_quired
Diphtheria Toxoid
(usually administered as DPT, DT, DTaP or TD)
Pertussis and Tetanus
(Children born on or after 1/1105)
Oral Poliovirus (OPV, IPV or eIPV)
Hepatitis B
(K-12 students born on or after 1/1/93)
(preschool children born on or after 111/95)
Measles
(the first administered after 12 months of age and the
second after 15 months of age)
Mumps and Rubella
(administered after 12 months of age)
Haemophilus influenza type b (Bib)
3 doses
3 doses
3 doses
3 doses
2 doses
1 dose each
3 doses of conjugate vaccine or 1 Hib if
administered over 15 months of age.
(preschool children only)
1 dose for children born on or after 111/98
or after 111/94 and enrolling in 6th Grade
1 dose for children born on or after 1/1/94
and enrolling in 6th Grade
Varicella
Pertussis Booster
(administered as a Tdap vaccine)
My child,
, (Date of Birth)
Polio OPV (3 dates)
Diphtheria
1.
DPT (3 dates)
has completed the foUowing immunization(s):
MMR
Hepatitis B (3 dates)
1.
1.
1.
2.
2.
2.
2.
3.
3.
Polio Boosters
Diphtheria
l.
3.
Measles
VariceUa
1.
1.
1.
2
2.
2.
2.
3.
3.
Mumps
BIB Vaccine (pre-K)
RubeUa
Tuberculin
1.
1
1.
1.
PPD
Lead Screening
l.
1.
2.
Signature
Physician's
Boosters
,
(Pre-K)
"l
Tine Test
Tdap
2.
of Physician:
stamp:
Date:
_
PATCHOGUE-MEDFORD SCHOOLS
STUDENT REGISTRATION PACKET
STATEMENT OF INTENT TO OBTAIN PHYSICAL EXAMINATION
FOR NEW ENTRANTS
The New York State Education Law, Article 19, Sections 903 and 904, and school district
policy, require that students in prekindergarten
through twelfth grade entering the district for
the first time, submit documentation
that a physical examination has been conducted. This
examination may be provided by your health care provider or by our school physicians.
Please indicate your preference
below:
____
Health Care Provider (at your expense)
____
School Physicians
I understand that my child may be excluded from school if documentation
of a physical
examination is not presented to the school within fifteen (15) calendar days of today or if my
child has not been examined by a school-appointed
physician (at no expense to me).
Child's Name:
Signature
----------------
of Parent/Guardian
_
Date:
_
,,
14
.Emanuel Lutheran
179 East Main
631.758.2250
.HomcsruiSdloolwithCbrlst
Patchogue-Medford
School Office of Student
PHYSICAL
Name: .
Street Patchogue~
Fax631.758.2418
Health Services
EXAMINATION
Date of Birth
FORM
School:
Grade:
Physician: Please answer all information completely.
If this is a sports physical,
student's private physician subject to review by a school-appointed physician.
Ht:
wt:
Age:
Uncorrected
Vision: R
REQUIRED
L
R
_
FOR ALL ATHLETES:
L
_
_
it may be completed
by the
Blood Pressure:
Hearing: R
At Rest
Glucose:
Hemoglobin/HematocrH
_
Corrected
PULSE:
URINALYSIS:
School
Ne"W'York 11772
emaruuthpat:cb.sc.org
_
L
After Exercise
_
After Rest
_
Albumin:
_
_
(optional)~~~~
_
Immunization Update Information (optional)
Any History of:
Diabetes
Cardiac/Pulmonary
disease
Recent injury (within one year)
H. E. E. N. T.:
--:--:-_--:-:----:Seizure disorder
Post exertional syncope
Lymph Nodes:
Thyroid:
Scoliosis:
Musculoskel:
Neurological:
Urogenital:
Skin:
Heart:
Lungs:
Speech:~~~---------------General Condition:
_.:...
_
_
_
_
_
_
_
_
_
Gait:
--:::-Tanner:
_
Abdomen:
RECOMME~N~D~A~T~IO~N~S~:-------------------------------------------------Corrective/Protective
Lenses/Goggles
_ Distance only
required:
Mouth guard for contact sports (orthodonture or caps):
Knee/AnklelWrist
support:
"'--_____
Rest if back/limb pain occurs:
Protective HelmeUFlank guard/Athletic cup:
LIST ALL PRESCRIBED
_
---------------Knee Shin guards:
Rest if wheezing occurs:
_
_
_
MEDICATIONS:
,
\
REFERRALS/COMMENTS/FOLLOW-UP:
APPROVED
FOR PHYSICAL
EDUCATION?
AND STAMP
OF EXAMINING
YES:
_
NO:
_
LIMITATIONS:
SIGNATURE
PHYSICIAN'S SIGNATURE
PHYSICIAN
DATE OF EXAM
_
PHYSICIAN - PLEASE COMPLETE
FORM ON REVERSE SIDE
ADDRESS
fO_ . _ I _[ .
Student Health Appraisal Supplement
for Body Mass Index and Weight Status Reporting
This supplement should be completed and attached to student health appraisals for students in Kindergarten,
4th, ih or 10th grade. This information is required under New York State Education Law (Section 903) by the
beginning of the 2008 academic school year.
Student Name: ________________
Date of Birth __
First
Gender:
Last
o
Grade (Check One):
o
Male
o
o
1
mm
1
dd
Body Mass Index (8MI):
mm
,
_
yyyy
dd
Female
Kindergarten
Date of Measurement:
_;I
o
2
o
4
7
o
10
_
yyyy
_
Weight Status Category (Based on BMI percentiles for age and gender):
(Check ONE)
0
Less than 5th
0
5th through 49th
0
50th through 84th
0 85th
through 94th
0 95th
through 98th
0
99th and higher
Specify current diseases (Check ALL that apply):
o
o
o
o
o
10104/07
.,
Asthma
Diabetes, Type 1
Diabetes
I
Type 2
Hyperlipidemia
Hypertension
(High Cholesterol
or Triglycerides)
(High Blood Pressure)
2nd,
Preschool Registration Form
School Year: 2013-2014
Circle Program of Interest: M,W,F
T,TH
M-F
Time: Half-Day(AM)
Child’s Name _________________________ Male __
Address ____________________
Female __
Half-Day(PM)
Full Day
Child’s age as of Dec. 31, 2013 _____
City _____________ Zip ________ Home No. _________________
Date of Birth ___________ Home District _____________ Language(s) Spoken at Home ____________
Born in
____USA
____Other:_____________
Cultural Heritage: (Please check one. NY State forms request this information. Our best guess is made if not filled out).
American Indian/Alaskan Native __
Asian/Pacific Islander __
Hispanic __
Caucasian __
African American __
Multiracial __
Family Records
FATHER
MOTHER
Name: (Mr. Dr.) _______________________
Name (Mrs. Ms. Dr.) _______________________
Occupation ____________________________
Occupation _______________________________
Employer
____________________________
Employer
_______________________________
Address
____________________________
Address
_______________________________
Business Phone _________________________
Business Phone ____________________________
Cell Phone
Cell Phone
__________________________
_____________________________
Email _________________________________
Email ____________________________________
Marital status _________________________
Marital status _____________________________
Lives at home ______ Yes _____ No
Lives at home ______ Yes _____ No
Child Resides with ___ Mother
___ Father ___ Both
___ Guardian:________________________
Church Denomination _____________________
Church Denomination ________________________
Synod __________Pastor’s Name____________
Synod __________Pastor’s Name______________
Church Attendance: (Please circle one)
Church Attendance: (Please circle one)
Regular
Regular
Occasional
Rare
Child’s Baptismal Date _________
Child’s Social Security No.
Occasional
Rare
Dedication Date ____________
_______ - _______ - _______
Mother’s Social Security No. _______ - _______ - _______
Father’s Social Security No. _______ - _______ - _______
FOR OFFICE USE ONLY ----------------------*Please continue the form on the reverse side
Early Registration Fee (Due by Jan. 31st for next school year): ______ Tuition Freeze: _____
Office: Birth Certificate: ___
Added to class list: ___
Health Forms:
___
10/11/2012 Physical Form:
Immunization Form: ___
Regular Registration Fee: ________
Data Entered in Computer: ___
Emergency Contact Form: ___
Dental form ___
DN/JD Siblings:
Name
Age
School Attends
Grade
_____________________
______
________________________
______
_____________________
______
________________________
______
_____________________
______
________________________
______
To Enable us to care for your child in an Emergency when you cannot be reached, please furnish us with the following:
Doctor’s Name: ___________________________________
Phone: ____________________
If you are not at home, who may we contact should your child become ill and allow to pick them up?
1. Name: ________________________________ Phone No.________________________
2. Name: ________________________________ Phone No.________________________
3. Name: ________________________________ Phone No.________________________

If neither parent can be contacted, I authorize the school to take such emergency measures as necessary,
i.e. contact EMS. __________________________________________ (Signature)

I give permission for my child’s home phone number to be listed in a class phone chain. _______ (Initial)

I give permission for my child’s picture or appearance in any media to be used in displays, advertisements
and/or in the news or school’s website. ___________________________ (Signature)

We have reviewed the Parent Manual with our child and agree to cooperate in accordance with the policies
set forth in that document. _____________________________________ (Signature)
I would like to volunteer throughout the year in the classroom and/or to chaperon field trips. I understand
that I need to give the school office a copy of my driver’s license and that a background check will be done.
__________________________________________ (Signature)
Additional comments below as to known allergies, cardiac conditions, diabetes, asthma, special education
needs, accelerated programs, etc.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
NOTE:
There is a non-refundable registration fee that must accompany this application. A
Financial Agreement from the Business Office must be signed. A copy of the child’s birth
certificate is required for all new registrations. The registration form will be returned if process
is not complete.
*By signing, I show that I have read and understand the information described in this registration form.
______________________________
Signature
10/11/2012 _____________________
Date
DN/JD E
l Lutheran Scho
e
u
n
ol
a
m
Preschool Schedule
Full Time Student Schedule
9:00
9:20
9:45
10:00
11:00
11:30
12:30
12:45
1:00
2:00
2:20
2:35
2:55
3:00
Arrival
Coming Together
Snack
Center Activites
Lunch
Nap
Manipulatives
Carpet Time
Center Activites
Religion/Story Time
Snack
Music/Movement Outside Play
Closing
Dismissal
Morning Student Schedule
9:00
9:20
9:45
10:00
11:00
11:15
11:25
11:30
Arrival
Coming Together
Snack
Center Activites
Religion/ Story Time
Music/Outside Play
Closing
Dismissal
Afternoon Student Schedule
12:30
12:45
1:00
2:00
2:20
2:35
2:55
3:00
Arrival
Coming Together
Center Activies
Religion/Story Time
Snack
Music/Outside Play
Closing
Dismissal
Philosophy
God has placed on parents the primary responsibility to educate their children. Emanuel Lutherans Preschool
is designed to assist parents by providing a Christian Early Childhood Program where children are helped to
grow, learn, and develop physically, socially, emotionally, cognitively, and spiritually.
Our Goals:




provide an environment which supports the growth of the whole child in developmentally
appropriate ways.
help children experience and learn about God's love
encourage children to acquire self-esteem, concern for others, a sense of community and a
spirit of sharing
foster creativity, exploration, self-discipline, and a love of learning
Programs:
All programs are Christian based with a Bible story of the month which is integrated into the everyday
curriculum. Our staff recognizes all domains of each child, the physical, the social, the emotional, the
intellectual, and the spiritual as significant parts of the whole child.
Three Year Old Preschool: (3 years old by December 31)
Three year old preschool program is designed for children who will be three by December 31. This program is
available M-F full or half days. We also have MWF programs as well as T, TH programs. Morning sessions run
9-11:30, afternoon sessions run 12:30-3 and full day sessions are 9:00-3:00. The teachers create an on-going
theme- based curriculum that gives the children an opportunity to have many hands-on experiences. The
children develop positive relationships with their teachers and other children in a safe environment. The skills
our curriculum emphasizes are cognitive, language, social studies, math, music dramatic play, science, gross
motor and fine motor. We integrate these learning experiences/skills through nursery rhymes, colors, shapes,
Bible stories, and self-help skills.
Pre-Kindergarten: (4 year old by December 31)
Pre-Kindergarten is designed for children who will be four by December 31. This program is available M-F full
or half days. We also have MWF programs as well as T, TH programs. Morning sessions run 9-11:30, afternoon
sessions run 12:30-3 and full day sessions are 9:00-3:00. The teachers create and continue the on-going
theme-based curriculum that integrates the skills needed for kindergarten. This includes the ability to listen
well, follow directions, and continue to develop large and small muscle control. Literature, the alphabet, math
(including counting), beginning writing, health and safety, science, motor skills, social skills, art and music
appreciation, dramatic play, and self-help skills are incorporated into everyday activities. The teachers are
always aware of each child’s individual needs and they work with individual children, small groups of children
and the whole group.
PARENTS MOST FREQUENTLY ASKED QUESTIONS: 1. 2. 3. 4. 5. 6. 7. 8. Are home toys allowed at school? No. (A small stuffed toy is allowed for nap time, however.) How can my child celebrate his or her birthday in school? You may provide a peanut free snack to share with the class (label must not indicate that peanut product were made in the same facility.) This snack will be served by staff during the fifteen minute snack interval time. If your child has a summer birthday, please speak to the teacher about a day to celebrate. If I have a specific concern about my child and would like to speak to the teacher, what is the procedure? For the benefit and privacy of your child, please call the office to set up an appointment with the teacher. What happens if my child has a bathroom accident at school? Due to health code rules, the staff is not permitted to change your child. If your child is unable to change his/her self, a parent will need to come to school. Please be diligent in making sure your child has an extra pair of clothes in their backpacks at all times and that they are weather appropriate. When is my child too sick for school? If your child has any of the following symptoms he/she is not permitted to come to school until symptoms have been gone for a 24 hour period or we have a doctor’s note:  Fever over 100.5  Unexplained rash  Vomiting/diarrhea  Nasal discharge which is not clear  Flu like symptoms What if my child is sent home from school with an illness? If your child is sent home from school for an illness during the day, they may not return for 24 hours. What is the best way to deal with separation anxiety? In our experience the longer a parent stays with the child the more difficult it is for the child. We are sensitive to the fact that many children have a difficult time in the beginning. Please know our staff is experienced with this and we will do our best to comfort and reassure your child. Does my child need a back pack? Yes, we send many things home and will be utilizing a folder for home/school communication. Please be sure your child’s back pack will fit an 8 ½ by 11” folder. Please be sure to check your child’s folder daily. This is also a place where you can place notes, lunch money and other important papers you want to send to school. (Please do not send tuition payments in this folder. They must go directly to the school office). 9. What do I send in for my child’s lunch? Please be aware that we cannot heat up food. Sandwiches, yogurt, granola bars, cheese and crackers are always good choices. Candy is not permitted. We will send home all leftovers. Hot lunch is also available. This must be purchased before the Thursday of the week before you would like your child to have lunch. We suggest you do this monthly. If you have any questions you can contact the school office. A monthly lunch menu will be sent home by hard copy or via e‐mail if you are registered for E‐mail, and you can fill out the menu and return it to the school before Thursday. Be sure to keep a copy for your records! 10. What should I bring in for my child for nap time? We suggest for both classes the all in one sleeping bag style mat. This contains a pillow and mat that the child will be able to roll and unroll easily. They are usually sold in Target. If you choose not to use this roll style sleeping bag then please follow the instructions for your teacher. Full Day Classes: A nap bag big enough to fit their travel size blanket, travel size pillow and crib sheet. Your child will learn to set up their cot and put their items away, so please be sure that the bag is big enough to fit all their items. Registration Check List
Please review the following list and use it as a guide to have a complete registration
packet. All of the following documents must be received upon registration. Incomplete
registrations will not be processed.
Preschool through 8th:
Registration Form
Registration Fee (Non-Refundable)
Updated Immunization Form
Financial Agreement Form
Birth Certificate
Only for: New registers to Emanuel, Preschool, Kindergarten, 2nd, 4th, and 7th:
Physical Form completed by your child’s physician (or signed Intent For a
Physical indicating the date of the appointment for your child’s physical
and your child’s physician’s name).
Kindergarten through 8th:
When you come to our office, be sure to schedule or sign the following forms:
Schedule a screening for your child.
Sign the Release of Records Form (for new transfers in 1st-8th grade).
Sign Transportation Form or visit your districts Transportation office if
you have no registered for transportation before April 1st.
Get location and information regarding pick-up of your child’s textbooks.
OFFICE USE: _______ Student’s previous records received
HOME AND SCHOOL WITH CHRIST Tuition Freeze locks in the current school year’s tuition rates and
is offered for returning students and new students if the
Non-refundable fees are paid by January 31, 2013.
Step 1:
Register for next year with the following registration fee schedule by January 31, 2013:
RETURNING STUDENTS:
REGISTER BETWEEN September 2012 - November 16, 2012
Early Non-Refundable Registration Fee: ……………………………………...
$ 75
PER CHILD
REGISTER BETWEEN November 17, 2012-January 31, 2013
Early Non-Refundable Registration Fee: ……………………………………..
$125
PER CHILD
$225
PER CHILD
$250
PER CHILD
NEW STUDENTS: Non-Refundable Fees
Preschool ($125 Registration fee -$100 applied to 1st months tuition)…
Kindergarten through Middle School Registration fee...
Step 2:
Sign the form below and return to the Business Office no later than January 31, 2013. This will
let the Business Office know that you are taking advantage of the tuition freeze and agree to pay the
following non-refundable tuition installment NO LATER than June 1, 2013:
$250
$375
(One child attending Emanuel Lutheran School)
(Families with 2 or more children attending Emanuel Lutheran School)
This amount will be deducted from your first tuition payment, which is due by August 1, 2013.
Your payment booklet will arrive in the mail during the summer.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐SIGN THE FORM BELOW AND RETURN TO BUSINESS OFFICE………………………………………………….. Student’s (Family) Name ________________________ Grade(s) (2013‐2014) ______________
I want to take advantage of the Tuition Freeze for the 2013‐2014 school year! ____ I have already registered and paid the non‐refundable registration fee for the 2013‐2014 school year! ____ I have enclosed my non‐refundable Registration Check of $__________ I agree to pay the Non‐refundable Tuition Installment of $________________ by June 1st. Parent Signature _______________________________________________ Date __________________
10/1/12 Page 1 of 1 DN/JD Fee Schedule & Tuition Freeze Rates - 2013-2014
TUITION FREEZE LOCKS IN THE CURRENT SCHOOL YEAR’S TUITION RATES LISTED BELOW AND IS OFFERED
FOR RETURNING STUDENTS AND NEW STUDENTS IF THE NON-REFUNDABLE FEES ARE PAID BY
January 31, 2013. (Please contact the school Business Office for more information on the requirements to qualify for a Tuition Freeze.)
Non Refundable Fees:
Tuition:
Returning Students - Fee paid between:
September 2012 - November 16, 2012………………..….……...…...
$ 75 (per child)
Returning students - Fee paid between:
November 17, 2012 - January 31, 2013 ……..................................
$ 125
(per child)
Returning Students - Fee paid After February 1, 2013………..…..
$150
$125
$100
$ 25
(1st child)
(2nd child)
(3rd Child)
(4th child)
New Students (Preschool)$125 Registration-$100 applied to 1st months tuition..
$225
(each child)
New Students (K-8th) includes $25 Application Fee and $25 Entrance Exam Fee..
$250
(each child)
(10 monthly payments starting Aug. 1st)
These rates effective through our Tuition Freeze program until January 31, 2013.
New rates will be published by July 1, 2013.
Preschool:
AM or PM Half Day Program (9-11:30am or 12:30-3pm)
Two Half Days (Tues & Thurs) …………………...........................
Three Half Days (Mon, Wed, Fri) ……………………………….…….
Five Half Days (Mon – Fri.) …………………………………………...
$181
$253
$434
Full Day Program (9am-3pm)
Two Full Days Preschool (Tues & Thurs) …………………………..
Three Full Days Preschool (Mon, Wed, Fri) ………………………..
Five Full Days Preschool (Mon – Fri.) ………………………………
$354
$489
$734
Kindergarten – 5th grade (8:15am – 2:45pm) ……….
Middle School - (6th – 8th grade) 8:15am – 2:45pm ……..
$556
$631
After-Care & Before-Care:
Multiple Child Discount: (Taken off the lowest tuition amount) 40% Discount on Second Child’s Tuition
60% Discount on Third Child’s Tuition
80% Discount on Fourth Child’s Tuition
Pastoral Discount:
40% off
Hot Lunch: (daily includes milk) $3.50/day
10/11/2012 $7/hr
Before-Care is always available on days our school is in session. It
begins at 7am and is in the Preschool building. The grade school
children are walked to the main building to start the school day at
8:15am. The Preschool students stay in Before-Care until their class
begins at 9am. After Care begins at 3pm and goes until 6pm. Parents
and Guardians are asked to notify the school, in writing, if their child will
be in After-Care or call the school office at least by 12pm the day service
is requested. It is also available on certain days when school is closed.
Page 1 of 1 DN/JD !
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