Application:

Immanuel Preschool and Kindergarten

238 Reese Street – Scranton, PA 18508 (570) 961-9080

For Enrollment Beginning: ______

Today’s Date: ______

Program Options:

______: Preschool 3 Year Olds (Tuesday and Thursday 8:30-11:30) $110.00/month

______: Pre-K 4 Year Olds (Monday Wednesday and Friday 8:30-11:30) $150/month

______: Pre-K 5 Day (M-F 8:30-11:30; for older 4 year olds that have been through the program 1 year) $225/month

______: Afternoon Kindergarten (Monday-Friday 12:00-3:00 pm) Must be 5 by September 1st $225.00/month

______: Full Day Kindergarten (Monday-Friday 8:30-3:00 pm) must be 5 by September 1st. $275.00/month

**Some of the program options listed above may be flexible so inquiry within with any questions you may have

** Before and After Care Services Available through our ‘sister school’ The Lutheran Academy. You can reach them at (570) 815-0917

Student’s Full Name: ______

Address: ______City: ______Zip:____

Home Phone: ______Cell Phone: ______

Date of Birth: ______Place of Birth: ______

Father’s Name: ______Mother’s Name: ______

Occupation and Business of Parent(s):

Father______

Occupation Business Address Phone #

Mother______

Occupation Business Address Phone #

Name and Ages of siblings:______

______

______

Is child baptized? ______yes ______no

Religious affiliation of Father: ______Mother: ______

Did you child attend any schools previously? ______yes______no

______

Dates attended Name of school and address

How did you hear about Immanuel Preschool and Kindergarten?

______

Please List: Physical or emotion handicaps, speech difficulties, allergies, etc.

______

Behavioral Problems: Does your child have any particular behavioral problems that would present difficulties in a whole group school environment? Please explain:

______

How would you describe your child’s personality?

______

What are your child’s favorite pastimes or interests?

______

Is your child exceptionally shy or timid?

______

Immanuel Preschool and Kindergarten serve children of any race, color, religion, national and ethnic origin; equally providing all rights, privileges, programs and activities accorded the students in our entire school program.