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Registration
2023-2024 Form
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* Indicates required question
Email
*
Your email
Child's Name
*
Your answer
Home Address
*
Your answer
Gender
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Age Group
*
3 years old
4 years old
5 years old
Has your child attended preschool before?
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Yes
No
If so, which preschool?
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Your answer
When was your child potty trained?
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Your answer
**All students must be potty trained before the first day of preschool.
Does your child live with both parents?
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Yes
No
*If parents share custody, please submit a copy of the court shared agreement for your child's file.
Are there other siblings in the household? If so, please list the names and ages of each sibling.
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Your answer
List a few of your child's favorite things.
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Your answer
What are some of your child's fears?
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Your answer
Do you have any concerns about your child attending preschool?
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Your answer
What are your expectations for preschool?
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Your answer
May we use your child's photo for public advertising and social media?
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Yes
No
Other:
May we put your name and contact information on the class list that will be given to other parents whose child is in the same class?
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Yes
No
How did you hear about SuperTREASURES Preschool?
*
Your answer
Mother/Guardian Full Name
*
Your answer
Mother/Guardian Address
*
Your answer
Mother/Guardian Phone Number
*
Your answer
Mother/Guardian Employer
*
Your answer
Mother/Guardian Business Address
*
Your answer
Mother/Guardian Business Phone Number
*
Your answer
*If Father/Guardian information is the same as the Mother/Guardian, please write "same as above".
Father/Guardian Full Name
*
Your answer
Father/Guardian Address
*
Your answer
Father/Guardian Phone Number
*
Your answer
Father/Guardian Employer
*
Your answer
Father/Guardian Business Address
*
Your answer
Father/Guardian Business Phone Number
*
Your answer
List persons authorized to pick-up your child. Include name, relationship to child and phone number. *ID verification will be required for all authorized persons.
*
Your answer
List child's doctor information including name of practice and contact information.
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Your answer
List the name, relationship and phone number for two emergency contacts.
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Your answer
Are all immunizations up to date? If not, please provide a copy of your religious exemption.
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Your answer
*Please submit a copy of your child's immunization records for their file.
Please list any allergies your child may have.
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Your answer
*Please note, we do not administer any medications with the exception of an EpiPen.
Does your child have any special needs, if so, please describe.
*
Your answer
Please describe any other relevant health information (past or present).
*
Your answer
A copy of your responses will be emailed to the address you provided.
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