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Re—Enrollment Application for 2017-18 Pastor Jeremy May 580 - 762 - 1111

First Lutheran Church & School

Principal David Birnbaum

1104 N. 4th St—Ponca City, OK 74601

580 - 762 - 9950 School Fax 580-762-4243

“Grow at First”

Please complete the following information.

Student Name:

□ Check if new address or cell number

Student Name:

Parent / Guardian Name: __________________________

Student Name:

Address: _______________________________________

Student Name:

City/State/Zip ___________________________________

Student Name:

Cell #: ________________________________________ Pre-School 3-year old has the option of Full Day (age 3 by 9/1/17) or Half Day programs. Space is limited.

Pre-Kindergarten has the option of Full Day (age 4 by 9/1/17) or Half Day programs. Space is limited.

Child’s birth date:____________

Child’s birth date:__________

Full-Day ____ 8:20-3:10

Full-Day ____ 8:20-3:10

Half-Day ____8:20-11:00

Half-Day ____8:20-11:00

All students must re-enroll annually. Students now attending First Lutheran will receive priority through Feb. 28. New applications will be considered on March 1. A payment plan is available (1/3 due immediately, 1/3 due March 31, and final payment by April 30). A portion of the enrollment fee is refundable when cancellation is necessary: 60% if requested before June 1; 40% from June 1 to August 1. ***No refunds after August 1***

To reserve a place, 1/3 of the enrollment fee must be paid with this form and all paid by April 30. Enrollment Fee Pre-School & Pre-Kindergarten (Half days) $270.00 Pre-School & Pre-Kindergarten (Full School days) $370.00 Kindergarten thru 5th grade $370.00 Grades 6th – 8th $470.00

Discount rate if paid by April 30 ($220 if paid in full by April 30) ($320 if paid in full by April 30) ($320 if paid in full by April 30) ($420 if paid in full by April 30)

NEW Referral Credit: $200 credit to ANY current school family for each new family to our school that enrolls in grades 1st – 5th that states on their application that they were referred to by that family. The current school family will receive the $200 credit in January for each of those new students in 1st-5th grade that remain enrolled through the first semester. There are multiple discounts available. Please review the financial page and tell us which tuition payment plan you intend to use.

Payment Plan Options:

□ 1 Payment □ 2 Payment □ 9 months

□ 12 months (starts in June)

□ Member

Your Signature ______________________ Print Name ______________________ Date_____________

Growing up, Reaching Out, and Walking together with Jesus at First Lutheran Church & School. First Lutheran’s 90th Anniversary Year Theme Verse (1925-2015) Lord, you have been our dwelling place throughout all generations. Psalm 90:1

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