Saint Daniel's Lutheran Church
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Student Registration Form for St. Daniel's Preschool, Robesonia, PA

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Applying for: (check one)

To the best of my/our knowledge all registration and health information is correct. Any images recorded while participating in Preschool/church activities may be used for the organization's promotion free of any claims. I give permission for my child to participate in all Preschool/church activities except as noted and I/We hereby release St. Daniel's Preschool, it's officers, directors, employees, and agents from any claim or loss incurred by reason of accident or injury to my/our child and do hereby covenant and agree to indemnify employees and agents from any claim or loss arising from an accident or injury to my/our child.

In the event of an emergency, I give permission to the medical personnel or staff selected by the Preschool/church to secure and/or administer any medical or emergency treatment, including hospitalization, deemed necessary for my child. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. I give permission to the Preschool/church to arrange necessary transportation for my child. I understand that the Preschool/church  is not responsible for medical costs due to illness or injury while participating in this Preschool/church and I agree to cover costs associated with any such illness or injury. I am the primary carrier of the accident/health insurance. If all immunizations required for school are not up to date, I understand and accept the risks to my child from not being fully immunized.

By submitting this form, we the parent/guardian(s) give full consent for my/our child to attend St. Daniel's Preschool if admission is still available. St. Daniel's Preschool does not discriminate against applicants or students on the basis of race, color, gender identity and national or ethnic origin.


Registration fee will be charged to your card