Registration Form

ST. MATTHEW’S LUTHERAN PRE-KINDERGARTEN REGISTRATION FORM
756 West Wabasha Winona, MN 55987 Phone: (507) 454-3083

Registration For:*
- 2-Day Classes
- 3-Day Classes
- 5-Day Classes
Date*
Child's Name*
First Middle Last
Address*
Street Address City State ZIP Code
Home Telephone*
Email*
Place of Birth
Date of Birth*
Baptized
- Yes
- No
Church
Family Information
Father/Guardian*
First Last
Address*
Street Address City State ZIP Code
Cell Phone*
Father's Place of Birth
Father's Occupation
Church Membership at:
Mother/Guardian*
First Last
Address*
Street Address City State ZIP Code
Mother's Place of Birth
Cell Phone*
Mother's Occupation
Church Membership at:
Other Children in the Family:
Please provide the following information for the other children in the family: •Name •Date of Birth •School Now Attending •Church where Baptized
Child lives with:
- Parents
- Father
- Mother
- Other
Please Explain
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Family Information