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Meadowlane Nursery School
 Call us at: 402-486-1414
MEADOWLANE NURSERY SCHOOL
8320 Elizabeth Dr.
Lincoln, NE 68505
402-486-1414

  (Please include a $50.00 non-refundable REGISTRATION/SUPPLY fee.)

                                             Circle class preference:      4-5 year olds       MWF am 
      
                                                                                4-5 year olds        M-Fam          


Child’s Name _______________________________________________     Preferred Name _____________________

Gender M/F                                                                                                                      Birthdate _____ /______ /______

Home Address________________________________________   City __________________      Zip ______________

Home/Primary Phone ___________________________     e-mail address ____________________________________

Mother’s Name ___________________________________   Father’s Name__________________________________

Place of Employment _____________________________     Place of Employment ____________________________

Mother’s Work Phone ____________________________      Father’s Work Phone ____________________________

Mother’s Cell Phone ____________________________        Father’s Cell Phone _____________________________

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If unable to reach parents, name of next contact ________________________________________________

Next contact Phone ________________________________________________

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Medical Information/Allergies ___________________________________________________________________

Child’s Physician ____________________________________ Phone ____________________________

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Child’s Siblings:
      Name ________________________ Age _______        Name ________________________ Age _______

      Name ________________________ Age _______        Name ________________________ Age _______

Referred by _________________________________ Other preschool experience ___________________________

I understand that the $50.00 registration/supply fee accompanying this application does not apply to the first month’s tuition and is non-refundable. It will assure my child’s place in school. Please make all checks payable to Meadowlane Nursery School.

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  Parent Signature                                                                      

2018-2019