Student's Name (First) (Middle) (Last) Address (Street) (City) (Zip)

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1 TRINITY LUTHERAN CHURCH & SCHOOL * 3016 West Vine Street * Kissimmee, Florida * (407) Application for Enrollment Pre-K 3 - Tenth Grade * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Student's Name (First) (Middle) (Last) Address (Street) (City) (Zip) Child s Age: Student's Birth Date / / Ethnicity Phone Home: Mother Name Cell Phone Occupation Employer Work Phone Church Membership (name of congregation) Religion Father Name Cell Phone Occupation Employer Work Phone Church Membership (name of congregation) Brothers and Sisters Age Grade Name Name Name *Active members of Trinity Lutheran Church/Kissimmee are required to pay the registration fee. The definition of active member for the purpose of registration only is: families must worship at least once a month on average throughout the year and contribute a minimum of $300 per year per family to Trinity Lutheran Church. A $300 credit will be applied toward the fee balance paid by the active member due I understand that $325/$375 of the Registration Fee must accompany this application and is non-refundable unless Trinity is unable to accept the child. Registration is contingent upon review of academic and behavioral records. I UNDERSTAND THE REGISTRATION FEE BALANCE IS DUE ON OR BEFORE APRIL 21, 2017 TO GUARANTEE ENROLLMENT OF MY CHILD. THIS IS ALSO NON-REFUNDABLE. A $ DISCOUNT WILL APPLY IF THE REGISTRATION FEE IS PAID ALL FEES ARE NON-REFUNDABLE Registration Fee Pre-K-5th Gr $775.00* Cub Corner Deposit-VPK EXT.. $ Due at time of Registration--PreK-5th Gr $ Bal. of Registration due for Pre-K-5th Gr... $450.00* *$100 discount towards Registration Fee if paid by 4/21/17. ******************************************************************************************************************************* Registration Fee- 6th-7th-8th-10th Gr.... $825.00* Due at time of Registration-6th-10th Gr. $ Bal. of Registration Due for 6th-10th Gr...$450.00* *$100 discount towards Registration Fee if paid by 4/21/17. ******************************************************************************************************************************* Tuition: Pre K 3 & 4 (Non VPK).... $5, Tuition: Cub Corner-VPK EXT $3, Tuition: Kindergarten-5th $5, Tuition: 6th-10th $6, BY APRIL 21, Note: Students with McKay or Step Up for Students Scholarships are not required to pay a initial registration fee deposit when they turn in the enrollment forms as this amount along with the activity fee will be calculated in the monthly copayments. If a child is withdrawn registration and activity fee will be payable before records are release. However, McKay and Step-Up Students do need to submit all enrollment forms in order to guarantee enrollment. I also understand that the tuition payment preference choice must be checked below. If the monthly payment plan is chosen, the Thrivent Simply Giving Tuition Payment Plan form must accompany this enrollment application in order for registration to be complete. I further understand that Trinity School uniforms are mandatory (purchased from Authorized Vendor only) for grades K-9 and optional for Pre-K students. PARENT/GUARDIAN INITIALS: Tuition Payment Preference: 1. Annual payment 2. Semi-Annual payment 3. Monthly (Mandatory Automatic Withdrawal through Thrivent) 4. Mastercard/Visa (See over for further explanation) 5. Payroll Deduction (Trinity Staff Option Only) PARENT'S SIGNATURE DATE * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Office Use: Registration Fee Received Bal. Reg. Fee Received Grade/Class Start Date

2 Trinity Lutheran School Student s Name: Where did your child last attend school? School Name & School Address: City: State: Zip: Phone# Has Student Ever (please check all that apply) Attended Trinity Lutheran School? If yes, when? and what was the reason for leaving? Repeated a grade? If yes, which grade? and what was the reason? Skipped a grade? If yes which grade? and what was the reason? Been assigned an alternative curriculum? If yes, please explain Been referred to anyone for academic evaluation or special testing to diagnose a learning disability? If yes, what was the diagnosis? Been on an IEP (Individual Education Plan) or an AIP (Academic Improvement Plan)? If yes, explain the current status of the student: Active in ESE classes, on monitor status or has exited the program. Been placed on curriculum modifications/accommodations? If yes, for what reason? Been dismissed, withdrawn, suspended or expelled from school? If yes, briefly explain None of the above A conference may be required with applicant. Missing or omitted information renders application invalid I understand that there are four options for payment of tuition: POLICY FOR PAYMENT OF TUITION 1) Payment in full with check or cash by , with a 5% discount. 2) Two payments ( & ) by check or cash, with a 2.5% discount. 3) 10, 11, or 12 monthly payments, mandatory automatic withdrawal through the Thrivent Financial Simply Giving Tuition Payment Plan from a checking or savings account on the 5th or 20th of each month, beginning June (12 payments), July (11 payments), or Aug. (10 payments). (Discounts do not apply.) 4) Payment in full by with MasterCard or Visa. This may be divided into two semesters, payable on & (Discounts do not apply.) DELINQUENT TUITION POLICY A $30.00 late fee will be charged by Trinity, if the required amount is not in your account the day scheduled for withdrawal. The tuition payment must then be brought to Trinity. Should this situation occur more than two times, the balance of the semester tuition will become immediately due. Trinity Lutheran School has no ongoing tuition assistance available. Should parent(s) become two months delinquent in tuition payments, without having made hardship arrangements with the Principal, termination of attendance will result. In any case, to register for the next school year, all financial arrangements must be fulfilled. To begin school, the total registration fee including late charges must be paid. If fees and tuition are not up to date at time of withdrawal or graduation, records cannot be transferred and report cards will not be issued. If a student is withdrawn during the school year, payment for the current 9 weeks grading period will be required. Any excess tuition payments will be refunded, minus any outstanding financial obligation. I (we) have read the tuition payment policy and understand the rules as stated. All arrangements for payment of tuition under the chosen method are the responsibility of the parent. Print Parent/Guardian Name: Date: Signature Parent/Guardian:

3 Trinity Lutheran School West Vine Street Kissimmee, FL EMERGENCY INFORMATION FORM Please Print Clearly * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Student's Full Name: Birth Date / / Address: Home Phone Address Mother's Full Name: Cell Phone: Mother's Work: Work Phone (Company Name) Father's Full Name: Cell Phone: Father's Work: Work Phone (Company Name) I hereby authorize the following people to assume temporary care of my child if I cannot be reached in case of illness or emergency. I am also giving permission for the person(s) listed below to be able to pick up my child from school. I expect Trinity Lutheran School to ask for a picture I.D. when someone other than myself picks up my child(ren) for verification. Remarks: Allergies/Conditions: Current Medications: I have medical insurance with: My policy number is: Local physician's name: Phone: *I give permission for my child to be given Fever Reducer/Pain Reliever if needed (Yes or No) Mylanta (Yes or No) Anti-Itch Cream (Yes or No) Benadryl liquid (Yes or No) Local dentist's name: Phone:

4 EMERGENCY/ACCIDENT AUTHORIZATION FORM Trinity Lutheran School 3016 W. Vine Street Kissimmee, FL IN CASE OF ACCIDENT or serious illness, I request the school to contact me. If the school is unable to reach me, I hereby authorize the school to call the physician indicated on the Emergency form and to follow his/her instructions. If it is impossible to contact the physician, the school may make whatever arrangements seem necessary. SIGNATURE OF PARENT OR GUARDIAN: State of Florida County of Osceola Driver s License # Printed name: Before me this day personally appeared the above-signed parent or guardian who, being duly sworn deposes and says, herein, this is a true and correct statement. IN WITNESS WHEREOF, my hand and official seal, this day of,20. NOTARY PUBLIC, state of Florida at large. My commission expires:

5 STUDENT ACTIVITY FEE In order to assist parents with payment of some student activities a Student Activity Fee is required and may be added to your choice of tuition payment plan (see options 1,2,3,4). This fee will cover the cost of class field trips, class photos, classroom parties, school newspaper, yearbook, etc. The fee for : Pre-K 3 $80.00 Pre-K 4 Not applicable - VPK Kindergarten- $ (Including Kindergarten Graduation) Grades 1,2, 3- $ Grades 4 & 5- $ Grades 6, 7, 8, 9 & 10 $ Please Note: this fee does not include the cost of individual photo packages, chaperones on field trips, lunches, clubs or sports, etc. PAYMENT OPTIONS: (PLEASE CHOOSE ONE) 1. Pay in full by July 3, Make in 2 payments: 1/2 due July 3, /2 due December 1, Choose monthly payment plan: 10, 11 or 12 month-this amount will be included with your tuition payment. 4. Pay in full by Credit Card due July 3, 2017 or 2 payments: 1/2 due July 3, /2 due December 1, 2017 STUDENT NAME: Grade: PARENT SIGNATURE: Date:

6 FORMS NEEDED FOR ENROLLMENT SHOT Records Trinity Lutheran School 3016 West Vine Street Kissimmee, FL Birth Certificate PRE K3 AND VPK A certified copy of your child s birth certificate bearing a raised seal. Immunization Forms - We need HRS Form 680 or HRS Form 81 (religious exemption). HRS form must show varicella vaccine or parent must send in a note to the school stating their child has already had the chicken pox. NO STUDENT WILL BE ALLOWED TO ATTEND SCHOOL WITHOUT THIS ORIGINAL FORM. Emergency Form and NOTARIZED* Emergency/Accident Authorization form. A complete school physical HRS Student Health Examination (HRS Form 3040). This form must be filled out by your doctor. Let your doctor s office know you will need this form to be filled out to turn in for your child s school file. KINDERGARTEN A certified copy of your child s birth certificate bearing a raised seal. Immunization Forms - We need HRS Form 680 and HRS Form 81 (religious exemption). HRS form must show varicella vaccine or parent must send in a note to the school stating their child has already had the chicken pox. NO STUDENT WILL BE ALLOWED TO ATTEND SCHOOL WITHOUT THIS ORIGI- NAL FORM. Emergency Form and NOTARIZED* Emergency/Accident Authorization form. A complete school physical HRS Student Health Examination (HRS Form 3040). This form must be filled out by your doctor. Let your doctor s office know you will need this form to be filled out to turn in for your child s school file. SIXTH GRADE It is recommended that all sixth graders receive a physical before school starts. Parents should check with their child s doctor to be sure all immunizations are up to date. SEVENTH GRADE All students entering seventh grade must turn in an updated original immunization form to show that they have completed the series of 3 hepatitis B shots, a second MMR and a TB immunization in order to start school. ALL STUDENTS All students must have the proper Florida immunizations. We must have a copy of HRS Form 680 and HRS Form 3040 or HRS Form 81 (Religious Exemption) on file for each student in Kindergarten through Eighth Grade. We must have a copy of HRS Form 680 or HRS Form 81 (Religious Exemption) on file for all PreK students. l All students (Pre K - Eighth Grade) must have a copy of their birth certificate on file. If you have previously submitted the immunization form and physical examination forms and birth certificate, it is not necessary to do so again. However, be sure the immunization form has not expired. New Emergency Forms must be filled out along with the new Notarized Emergency/Accident Authorization every school year for ALL students. Please bring any updated Florida immunization and physical forms to the office so we can update your child s file. Complete local county health department guidelines can be accessed from the Department of Health, Bureau of Immunization web page at Click on County Health Department Services and scroll down to immunizations. * Church Office Administrator is available to notarize forms.

7 Student Photo Release Form The Trinity Lutheran Church and School website and brochures are used to communicate with school families, teachers, prospective students, and the larger community. To enhance this experience we use photos to show student involvement in various activities. In order for students images to be used we need to obtain parental permission. Please fill out the following form acknowledging your preference. Student s Name I am the parent or legal guardian of the child named above. I understand the possible publication of my child s image being used in promoting Trinity Lutheran Church and School and agree to the following: ( ) I DO give permission to TLC&S to use my child s image. ( ) I DO NOT give permission to TLC&S to use my child s image. Signature of Parent/Guardian Date: