Dillsburg Preschool Registration - Trinity Lutheran Church, Camp Hill & Dillsburg PA

Child's Name

First Last

Child's Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Date of Birth:(Required)

Name you would like your child to be called at school:

Parent/Guardian 1

Name

First Last

Relationship to child:(Required)

Email(Required)

Cell Phone(Required)

Parent/Guardian 2

Name

First Last

Relationship to child:

Cell Phone

To register for the 2-½ year-old class, your child MUST be 2 years of age by February 28, 2026.
To register for the 3-year-old class, your child MUST be 3 years of age by August 31, 2026.
To register for the 4-year-old class and 4 & 5-year-old Pre-K class, your child MUST be 4 years of age by August 31, 2026.

Classes:(Required)

Additional Information

Please list the name and ages of all other children living at home.

Please list the names and relationships of all adults living in the child's home (including parents.)

Does your child speak and understand English (basic instructions, common words, etc.)?

Yes

Does your child have prior preschool experience?

Yes

If yes, where did they attend? For how long?

Does your child have allergies?(Required)

Yes

If yes, please list.

Do you have concerns about your child's development in any of the following areas. Check all that apply.

Speech and Language

Learning and Thinking

Small or Large Motor Skills

Social and Self-Help

None

Has your child ever been evaluated or received an IEP for developmental, cognitive, emotional, physical, or behavioral delays?(Required)

Yes

If yes, please provide information on whether your child is qualified for services or is receiving services through the CAIU or outside agencies such as specialized instruction, occupational therapy, physical therapy, behavioral instruction, speech therapy, or RBT one-on-one support staff.

Will your child require assistance in the bathroom?(Required)

Yes

If yes, please explain.

What does your child enjoy playing with?

Is there anything that we can do to make preschool a positive experience for your child?

Is there any additional information you would like to share with us concerning your child or family?

**Important Notice: Trinity Preschool actively values inclusiveness and student diversity. However, we are NOT cognitive/behavioral specialists; our priority is to ensure all our students are in a program that meets their needs. Children with no prior evaluation history but presenting significant delays and behaviors may be referred to the CAIU for an evaluation. Trinity reserves the right to withdraw enrollment if the child's guardian does not follow through on the requested evaluation or if behavioral and safety concerns cannot be supported in our classrooms.