TLS-REGISTRATION FORM
**DO NOT USE A CELL PHONE TO COMPLETE THIS FORM** This Registration Form must be electronically signed by both parents. Complete one form per student. Complete all fields on this form before clicking Submit. You are unable to modify the form once submitted. If any areas are incomplete, a new form will need to be completed. Upon clicking SUBMIT at the end of this form; the system does not provide a confirmation response. You will be contacted by TLS within two business days to acknowledge receipt of your form.
STUDENT INFORMATION
Last Name
First Name
Middle Name
Grade
Date of Birth	JanFebMarAprMayJunJulAugSepOctNovDec0102030405060708091011121314151617181920212223242526272829303120292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926
Place of Birth
	Male
	Female
Date of Baptism	JanFebMarAprMayJunJulAugSepOctNovDec0102030405060708091011121314151617181920212223242526272829303120292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926
Church Membership
Family Mailing Address (Street)
Apartment Number
City
State
Zip Code
Phone Number
Race (Check all appropriate. Question is for statistical purposes only.)
	African American
	Asian
	Caucasian
	Hispanic
	Native Hawaiian
	Pacific Islander
	Other
If Other, please specify
Please list any difficulties and/or limitations (academic, emotional, physical, etc...) your child may have had at school.
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1
Name (Title, Last, First)
Relationship to Student
Occupation
Employer &/or Military Branch of Service
Cell Phone
Alternate Phone
Home address (if different from child)
Email address
Lives with student?
	Yes
	No
Parent/Guardian #2
Name (Title, Last, First)
Relationship to Student
Occupation
Employer &/or Military Branch of Service
Cell Phone
Alternate Phone
Home address (if different from child)
Email address
Lives with student?
	Yes
	No
PICK-UP AUTHORIZATION & EMERGENCY CONTACTS
Aside from Parents/Guardians, please list contacts for those you authorize to pick-up your child from school. Every effort will be made to contact Parents/Guardians in case of emergency. If you cannot be reached, please list contacts that may be contacted to make emergency decisions for your child.
Contact #1, Name
Relationship to Student
Daytime Phone
	Authorized Pick-up
	Authorized Emergency Contact
Contact #2, Name
Relationship to Student
Daytime Phone
	Authorized Pick-up
	Authorized Emergency Contact
Contact #3, Name
Relationship to Student
Daytime Phone
	Authorized Pick-up
	Authorized Emergency Contact
Contact #4, Name
Relationship to Student
Daytime Phone
	Authorized Pick-up
	Authorized Emergency Contact
SIGNATURES
The information on this registration form is true and correct. We accept financial responsibility for the payment of all Trinity Lutheran School and day care tuition and fees. Both electronic signatures from Parents/Guardians are required.
#1 Parent/Guardian E-signature
Date	JanFebMarAprMayJunJulAugSepOctNovDec0102030405060708091011121314151617181920212223242526272829303120292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926
#2 Parent/Guardian E-signature
Date	JanFebMarAprMayJunJulAugSepOctNovDec0102030405060708091011121314151617181920212223242526272829303120292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926
Before submitting this form; please review to make sure all applicable fields have been answered. Upon clicking SUBMIT at the end of this form; the system does not provide a confirmation response. You will be contacted by TLS within two business days to acknowledge receipt of your form. Thank you!

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