Registration 2026-2027- Preschool Everett Form - Prince of Peace Lutheran Church

Student Information
Child's Name*
First Last
Preferred Name
This is the name they respond to and how it will appear on their class name tags.
Gender*
- Male
- Female
Birthdate*
MM slash DD slash YYYY
Address*
Home and mailing address.

Street Address City State ZIP Code
Address
Billing Address if different from home address.

Street Address City State ZIP Code
Enrollment Status*
- New Enrollment to our program
- Currently enrolled or have a sibling currently enrolled
- Previously enrolled in our program
How did you hear about us?*
- Friend
- Social Media Post
- Banner on the church
- Google Search

Parent/Guardian #1 Information
Parent/Guardian #1 will be the primary contact, especially for enrollment processes, billing statements, etc.
Parent #1 Name*
First Last
Parent/Guardian #1 Relationship to child*
Parent/Guardian #1 Phone Number*
Parent/Guardian #1 Email*
Parent/Guardian #1 Address (if different than child's)
Street Address City State / Province / Region ZIP / Postal Code Country
Parent/Guardian #2 Information
Parent/Guardian #2 Name*
First Last
Parent/Guardian #2 Relationship to child*
Parent/Guardian #2 Phone Number*
Parent/Guardian #2 Email*
Parent/Guardian #2 Address (if different than child's)
Street Address City State / Province / Region ZIP / Postal Code Country

Emergency Contact*
List someone other than Parent/Guardian #1 or Parent/Guardian #2 who is available during your child's class in case of emergency and Parent/Guardians #1 & #2 are unreachable or unavailable.
First Last
Emergency Contact phone number*
Consent*
I understand that every effort will be made to contact the parents of my child, should he/she need medical or surgical treatment. However, if it is impossible to do so, I hereby give my permission to the emergency physician to secure proper treatment for my child.
Name of person giving consent.*
First Last
Date*
MM slash DD slash YYYY
Registration Fee*
When you submit your registration you will be sent a link to set up your Brightwheel App account, where you will then be invoiced a $140 non-refundable registration fee plus a $3.90 processing fee. Your child will not be fully registered or placed in a class until your registration fee is submitted. Please check "I understand" to acknowledge you are aware of this process.
I understand.
CAPTCHA

Enrollment for School Year 2026-2027