Preschool Registration
Child's Name:
Child's Birthday:
Address:
Phone Number:
Is your child baptized? *
Mother's Name:
Mother's Occupation:
Mother's Employer:
Mother's Work Phone:
Mother's Address (if different than child's):
Mother's Marital Status:
 1 - Single
 2- Married
 3 - Divorced
 4 - Widowed
Mother's Church:
Member:
 1 - Yes
 2 - No
Father's Name:
Father's Occupation:
Father's Employer:
Father's Work Phone:
Father's Address (if different from child's):
Father's Marital Status:
 1 - Single
 2 - Married
 3 - Divorced
 4 - Widowed
Father's Church:
Member:
 1 - Yes
 2 - No
If there has been a seperation or divorce, with whom is the child living?
Persons authorized to pick up child, contact information, and relationship to child:
Other children in the family (names and ages):
Class selection for 2012/2013
 3yr-old: Tue and Thur 9-noon
 4yr-old: Mon, Wed, Fri 9-noon
 4yr-old: Mon, Wed, Fri  12:45pm-3:45pm


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Little Lambs of Peace, 11555 Birch Hills Drive, Eagle River Alaska ~ 907-694-3456