Kindegarden Enrollment | Immanuel Lutheran Church

Kindergarten Package Enrollment Form

School year

2025-2026

2026-2027

Child must be five years old by Sept 1st.

Students Last Name

Middle Name

Students First Name

Students Gender

Male

Female

Birthday

Month

Day

Year

If this is a transfer; School name, address and phone number of the school transferring from.

Parent(s) Name(s)

Address

Phone

Do you receive text at the above phone number?

Preferred method of contact

Emergency contact name, phone number and relation to student.

Will the student be using bus service?

Name(s) and relation of persons (other than parents) allowed to pick student up from school.

Please note anything medical or educational which is important for us to know:

Does this student experience siezures?

Yes

Church Membership

Students Baptismal Date

Month

Day

Year

Space will be reserved for your child only with payment of a non-refundable fee of $100, the fee increases to $125.00 after April 1.

Enrollment will be on a first-come, first-served basis.

Admission policies for the Early Childhood Program are that of Immanuel Lutheran School, namely that admission is open first to members of Immanuel Lutheran Church, secondly to members of sister congregations, thirdly, to children presently enrolled in the program, and finally, to the general public.

We occasionally take pictures

of the kids in action with the materials

or doing other activities for our website and/or Facebook page.

We hope to use these to keep parents

up to date on the happenings at school.

Certificate of Child Health Examination

State of Illinois Eye Examination Report

Proof of School Dental Examination Form

Lead Screening Test (children 6 and under living in zip codes 62214 and 62803)

Exam forms may be turned in at a later date as allowed by Illinois state law.

Blank forms may be downloaded at:

https://www.immanuelokawville.org/copy-of-school-1