Su Casa Preschool Registration Form
Thank you for your interest in Su Casa Preschool. Please fill out the form below for each child you wish to enroll. If you have any questions, please contact us via text: 844-400-1302 or send us an email at: preschool@sucasamemphis.org
What is your child's first name?
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What is your child's middle name?
What is your child's last name (s)?
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What is your child's preferred name?
If the child is used to a different name that you would like us to use, write it below (i.e. a shortened form of their name or a school-appropriate nickname).
What is your child's gender?
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What is your child's birthday?
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What language(s) is spoken at home with the child?
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You can select more than one option.
In what country was the student born?
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If the child was not born in the US, in what year did they arrive in the US?
Please write the 4-digit year below. You do not need to respond if the child was born in the US. For example: 2018
Where does the child live?
Write the child's street address. For example: 1234 State St
In what city and state does the child live?
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If the child's city/state is not listed, select "Otro / Other"
What is the child's zip code?
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Write the 5-digit zip code for the child. Only use numbers. For example: 12345
Does your child have any medical alerts or allergies that we should be aware of?
Is your child potty trained?
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Which class days would you like to attend?
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Classes are held in two groups: Monday/Wednesday OR Tuesday/Thursday. If you do not have a preference, please note that and we will assign you to the day with more space.
If your child is unable to attend Su Casa Preschool, where will the child go?
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This is not a firm commitment, just an idea. Your answer to this question helps us with our grants and funding.
Su Casa Preschool can use me or my child's photos, images, work, or words in promoting the work of the preschool.
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This also enables us to post photos of your child on our parent portal where you can see your child in action throughout the day.
If you have a picture of your child for us to include in their enrollment packet, please upload it here.
Having a picture ahead of time allows the teachers to start learning names and faces so that your child will feel comfortable from the first day.
Add image
Does your child have a sibling that will attend Su Casa Preschool?
If you are enrolling more than one child, please check the box below.
How many people live in the house with the child?
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Count the child as one and every other person who lives in the house as one. For example: me, my child, my husband and 2 other children = 5. Write the number below.
Which best describes the monthly income from all people in your household?
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We need to know how much money enters your household each month because this information helps us with our grants and funding. Please count the total from everyone who lives with you, not just your own paycheck.
What is Parent #1's first name?
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Parent #1 is the primary adult responsible for the child and the first person we will contact.
What is Parent #1's last name(s)?
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What is Parent #1's gender?
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If you use other pronouns, we will contact you to make sure we refer to you as you prefer.
What is Parent #1's relationship to the child?
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What is Parent #1's birthdate?
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What is Parent #1's country of origin?
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If Parent #1 was not born in the US, in what year did he/she arrive in the US?
Please write the 4 digit year below. You do not need to answer this question if Parent #1 was born in the US. For example: 2018
Is Parent #1's address the same as the child's address?
Check the box if the child lives with Parent #1. If the child lives with Parent #2, leave the box blank and fill out the following 3 questions.
What is Parent #1's street address?
Write Parent #1's street address. For example: 1234 State St
What is Parent #1's city/state?
If Parent #1's city/state is not listed, select "Otro / Other"
What is Parent #1's zip code?
Write the 5-digit zip code for Parent #1. Only use numbers. For example: 12345
What is Parent #1's phone number?
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We use a text messaging system to keep our parents informed. Please share the best number to reach you. We will also call if we need to reach you more quickly. Enter numbers only below. For example: 9011234567
What is Parent #1's email address?
If you have an email address, we can send you forms or paperwork digitally.
In what language does Parent #1 prefer to be contacted?
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Please select the best option for communicating with Parent #1. Our staff is able to communicate in English and Spanish.
What is Parent #1's highest level of education?
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What is Parent #1's type of work?
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If Parent #1 works, what is the name of the company he/she works for?
Does Parent #1 have a tax ID number?
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We at Su Casa are working with immigration lawyers to help make sure all of our families have what they need to obtain an ITIN or social security number. We are working to provide help if you need it to obtain a tax id number. Su Casa will never ask for your number to qualify for any service we offer. We also do not share this information with anyone outside of our organization.
What is Parent #2's first name?
If the child only has one parent, skip this section.
What is Parent #2's last name(s)?
What is Parent #2's gender?
If you use other pronouns, we will contact you to make sure we refer to you as you prefer.
What is Parent #2's relationship to the child?
What is Parent #2's birthdate?
What is Parent #2's country of origin?
If Parent #2 is not from the US, in what year did he/she arrive in the US?
Please write the 4 digit year below. You do not need to answer this question if Parent #2 was born in the US. For example: 2018
Is Parent #2's address the same as the child's?
Check the box if the child lives with Parent #2. If the child lives with Parent #1 but not #2, leave the box blank and fill out the following 3 questions.
What is Parent #2's street address?
For example: 1234 State St
What is Parent #2's city and state?
If Parent #1's city/state is not listed, select "Otro / Other"
What is Parent #2's zip code?
Write the 5-digit zip code for Parent #2. Only use numbers. For example: 12345
What is Parent #2's phone number?
We use a text messaging system to keep our parents informed. Please share the best number to reach you. We will also call if we need to reach you more quickly. Enter numbers only below. For example: 9011234567
What is Parent #2's email address?
If you have an email address, we can send you forms or paperwork digitally.
In what language does Parent #2 prefer to be contacted?
Please select the best option for communicating with Parent #2. Our staff is able to communicate in English and Spanish.
What is Parent #2's highest level of education?
What is Parent #2's type of work?
If Parent #2 works, what is the name of the company he/she works for?
Does Parent #2 have a tax ID number?
We at Su Casa are working with immigration lawyers to help make sure all of our families have what they need to obtain an ITIN or social security number. We are working to provide help if you need it to obtain a tax id number. Su Casa will never ask for your number to qualify for any service we offer. We also do not share this information with anyone outside of our organization.
Who is emergency contact #1?
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In case of an emergency, we will contact Parent #1, then Parent #2. If we cannot reach either of them, we will call these emergency contacts in this order. Please write the name of the person below.
What is emergency contact #1's relationship to the child?
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Please select the closest relationship this person has with the child. This helps us explain to the child who we are contacting if needed.
What is emergency contact #1's phone number?
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Write the phone number below. Use only numbers. For example: 9011234567
Is emergency contact #1 allowed to pick up the child from school?
If you check this box, we will allow your child to leave school with this person without contacting you first. Anyone who is not marked here will have to have prior permission from Parent #1 or Parent #2 and a photo ID to take your child from school.
Who is emergency contact #2?
In case of an emergency, we will contact Parent #1, then Parent #2. If we cannot reach either of them, we will call these emergency contacts in this order. Please write the name of the person below.
What is emergency contact #2's relationship to the child?
Please select the closest relationship this person has with the child. This helps us explain to the child who we are contacting if needed.
What is emergency contact #2's phone number?
Write the phone number below. Use only numbers. For example: 9011234567
Is emergency contact #2 allowed to pick up the child from school?
If you check this box, we will allow your child to leave school with this person without contacting you first. Anyone who is not marked here will have to have prior permission from Parent #1 or Parent #2 and a photo ID to take your child from school.
Write your full name below as your signature. The time and date of this signature will be saved as well.
By signing below, I acknowledge that I am the legal parent/guardian of this child and I have legal/shared custody. If I cannot be reached in the case of an emergency, I authorize the above person(s) and/or Su Casa Preschool to obtain necessary treatment for my child. I waive any claim of liability on behalf of Su Casa Preschool, its employees or volunteers for accidents/injuries or efforts to obtain treatment for my child. I also acknowledge the following: I understand that the Registration fee is non-refundable and must be paid to secure space in the program. I will provide a current record of immunizations and the birth certificate before the first day of attendance. I am aware that tuition is due before the 5th of the month (July-April) regardless of any days missed for illness, weather, travel, etc. A two-week written notice is required to withdraw my child from the program and all tuition must be paid in full up until that date. I understand that there are no reimbursements or refunds from Su Casa Preschool.
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